ABSTRACT
This chapter provides a case of a 67-year-old man with confused state. His wife is distressed because he repeatedly asks her to swat the flies from the ceiling, when she can see nothing there. He has been in bed for 3 days with a 'cold'. There are no abdominal signs and the cardiovascular system seems normal with good peripheral pulses. His temperature is normal. He has poor air entry and crackles over the right side of the lower lung, and he has bronchial breathing and dulled percussion in the same area. He has an increased respiratory rate. Drug or alcohol states seem unlikely given the history as does head injury although he may have knocked his head without his wife knowing. Rather than organizing tests and waiting for the results a hospital admission is appropriate to investigate and provide necessary treatment.
