Based on history and exam, presentation not consistent with PNA, Pertussis, Sinusitis, foreign body, PTA, RPA, Ludwig’s, Strep throat, Mono.

Workup: Defer imaging at this time as patient particularly low risk for PNA given: HR <100, RR <24, Temperature <38C, Exam findings not consistent with focal consolidation, Age <64yr.

Rx: Conservative care
Disposition: Discharge home w PCP follow up in next 3 days, Strict ED return precautions discussed. Pt educated regarding potential side effects, cost, and possibility for microbial resistance with antibiotics, hence why they are not receiving them.

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PEARLS

• Ddx
  • Viral URI
    • Consider inhaler for symptomatic relief
  • Bronchitis
    • Consider inhaler for symptomatic relief
  • B pertussis: URI for a week followed by prolonged paroxysmal sleep disturbing cough
    • Azithromycin 500 D1 followed by 250mg D2-5
  • GERD
  • Asthma
  • ACE-i’s
  • Atypical PNA
  • SARS:
    • Unlikely SARS (coronavirus) given no travel to China, no diarrhea, no severe respiratory compromise, nontoxic appearance, and other dx more likely
  • MERS:
    • Unlikely MERS (coronavirus) given no travel to Middle East, no diarrhea, no severe respiratory compromise, nontoxic appearance, and other dx more likely