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Great episode as always! Just one minor point I'd like to make. Low total CO2 on the chemistry does not necessarily mean acidosis. Of course we would need a blood gas to determine the acid base status. I am definitely not saying the patient needs a blood gas, but we cannot honestly comment on how the low total CO2 relates to his pH as he may be compensating for a respiratory alkalosis - which is definitely plausible given the clinical scenario of pneumonia.
I am noting a minor error in this content.
There was a comment that S. pneumoniae, if inspected by gram stain, appeared as gram positive cocci "in clusters", whereupon the histology teaching assistant within me cringed. The origin of the word "streptococcus" is from the Greek "streptos" or "twisted" and "kokkos" or "berries", referring to the appearance as twisted chains of berries on a string.
Contrast this with staphylococcus, which is from the Greek "staphyle", or "bunch of grapes", as it appears as clusters on gram stain.
What you do matters.