Table 4.

A case scenario illustrating the use of the ‘technical’ expert summary, BESD, pathological differential diagnosis and 5S therapeutic interventions

• 67-year-old male
• Bird/pigeon breeder, smoker
• 3-day history of fever, cough with yellow sputum, left stabbing chest pain that is worse with breathing and coughing and breathlessness
• Clinically, breathless, cyanosed, disoriented to time, person and place,
Temperature 39.1 °C
• BP 86/50 mmHg, RR 32/min, bilateral coarse crepitations, bronchial breathing left lower zone
• Chest X-ray: left basal consolidation
Summary
67-year-old, smoker and bird-breeder presenting with a 3-day history of productive cough, dyspnoea and left pleuritic chest pains
Clinically confused, cyanosed, febrile, tachypnoiec and hypotensive with signs of left lower zone consolidation
1. Bedside-clinical diagnosis	Community acquired pneumonia with septic shock
2. Cause/precipitant	Chlamydia psittaci
	Aetio-pathological differential diagnosis
	Other Infections: e.g. avian flu, cryptococcal infection
	Inflammatory e.g. collagenosis, allergic alveolitis
	Vascular e.g. pulmonary embolism
	Neoplastic, drug-induced etc.
3. Severity	Life-threatening (CURB-65 = 4)
4. Site of care	ICU
5. Symptomatic	Analgesia, anti-pyretic
6. Supportive	Oxygen, intravenous fluids
7. Specific	Antibiotics
8. Speciality referral	Intensive therapy unit, pulmonary service