Pneumonia with pleural effusion: ER approach

A 55-year-old man presents to the ER with 2 days of pleuritic chest pain, productive cough of yellow-green sputum, shortness of breath and fever. He has diabetes and hypertension and has smoked about a pack a day for 30 years. During your evaluation he reports sudden worsening of breathlessness and you find stony dullness on percussion.