What is the target?

doi:10.1136/bmj.b1604

Published 27 May 2009, doi:10.1136/bmj.b1604
Cite this as: BMJ 2009;338:b1604

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What is the target?

M Lemyze, specialist registrar in critical care medicine¹, S Salomon, specialist registrar in critical care medicine¹, D Brown, specialist registrar in emergency medicine², P Detouche, specialist registrar in critical care medicine¹, F Collet, specialist registrar in critical care medicine¹

¹ Department of Critical Care Medicine, Broussais Hospital, Saint Malo, France, ² Department of Emergency Medicine, Broussais Hospital, Saint Malo, France

Correspondence to: M Lemyze, Department of Critical Care Medicine, Broussais Hospital, 35400 Saint Malo, France malcolmlemyze@yahoo.fr

The first 150 words of the full text of this article appear below.

A 44 year old man was brought to the emergency department witha two day history of fever, skin rash, and a rapidly progressiveshortness of breath. On examination, notable observations includedan extensive rash, cyanosis, a fast respiratory rate (40 breaths/min),bilateral crackles on lung auscultation, and a temperature thatreached a maximum of 40.4°C. Arterial blood gas levels showedsevere hypoxemia (PaO₂, 48 mmHg; fraction of inspired oxygen[FiO₂], 21%). Chest radiography showed bilateral consolidationof the air spaces, mainly in the lower lung fields, which confirmedthe clinically suspected diagnosis of community acquired pneumonia(fig 1).

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Fig 1 Skin rash in a patient with community acquired pneumonia

1 What is the clinical diagnosis for the patient’s skinrash?

2 What is the most likely cause for his community acquiredpneumonia?

3 How should the diagnosis be confirmed?

4 Howshould this patient be managed?

1 . . . [Full text of this article]

Box 1 Main causes of erythema multiforme (in order of incidence)
Box 2 The CURB-65 score for assessing the severity of communityacquired pneumonia¹¹
Box 3 Validated criteria to determine admission to an intensivecare unit for a patient with severe community acquired pneumonia¹²¹³