Cough, vomiting and fever...

An 84-year-old nursing home resident underwent emergency open cholecystectomy under general anaesthesia. She has advanced Parkinson disease, hypertension, and diabetes, and was receiving nutrition via nasogastric tube (NGT). On the second postoperative day, she was noted to be coughing and vomiting. Four days later, she had a temperature of 102°F (38.8°C), heart rate of 90 beats/min, respiratory rate of 25 breaths/min, blood pressure of 120/70 mm Hg, and oxygen saturation of 87% on room air. She had a productive cough with what the nursing staff describes as "putrid sputum:' Lung auscultation showed crackles on the right and a chest radiograph revealed a patchy infiltrate in the right lung.