Patient A, a man 58 years of age, presents to the walk-in clinic complaining of a 24-hour history of fever and chills, with an episode of rigors last night. He has previous history that is significant for COPD, diabetes, and a 2 pack per day smoking habit and a lifetime pack year history greater than 75 years. His medications include a combination steroid/long-acting beta agonist inhaler, tiotropium bromide and albuterol, as needed. He complains of increased dyspnea and has been using his inhaler almost constantly. He admits to a productive cough but is not sure if it is much different than his normal "smoker's cough," as he calls it. The office medical technologist obtains vital signs, and Patient A has a blood pressure of 168/92 mm Hg, a pulse of 128 beats per minute, a respiratory rate of 32 breaths per minute, and a pulse oximetry on room air of 87%. His temperature (taken with a forehead "tape" thermometer) is 97.5°F. The patient is placed on 4 liters O2 and given an albuterol solution via small volume nebulizer. His O2 saturation increases to 94%, his respiratory rate decreases to 24 breaths per minute, and his pulse decreased to 112 beats per minute.