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A 72-year-old male patient with acute respiratory distress s…

A 72-year-old male patient with acute respiratory distress syndrome (ARDS) is receiving mechanical ventilation in the ICU. Over the past three days, the respiratory therapist and nursing staff have observed a decline in the patient’s respiratory and hemodynamic status. The patient has been requiring higher ventilator settings and the peak inspiratory pressures have been increasing.  The following data has been collected: Parameter Day 1 Day 2 Day 3 Urine Output (mL): 1000 800 600 Fluid Intake (mL): 2500 3000 3500 Net Fluid Balance (Intake – Output): 1500 2200 2900 Lung Compliance (mL/cm H₂O): 40 35 30 Peak Inspiratory Pressure (cm H₂O): 25 30 35 Mean Arterial Pressure (mm Hg): 85 80 78 CBC Parameter Day 1 Day 2 Day 3 White Blood Cell Count (K/µL): 11.2 13.8 13.5 Hemoglobin (g/dL): 12.5 12.2 11.8 Hematocrit (%): 36.8 35.5 34.2 Platelet Count (K/µL): 220 205 198 Renal Markers Day 1 Day 2 Day 3 Serum Creatinine (mg/dL): 1.2 1.5 1.8 Blood Urea Nitrogen (BUN) (mg/dL): 20 28 36 Estimated Glomerular Filtration Rate (eGFR) (mL/min): 70 58 50 Electrolytes Day 1 Day 2 Day 3 Sodium (mEq/L): 138 136 129 Potassium (mEq/L): 4.2 4.8 5.4 Chloride (mEq/L): 102 105 108 Bicarbonate (mEq/L): 22 21 20 Based on the data provided in the chart and the patient’s clinical presentation, what is the most likely cause of the patient’s declining condition?

A 61-year-old male with a 30-pack-year smoking history and a…

A 61-year-old male with a 30-pack-year smoking history and a 10-year diagnosis of chronic obstructive pulmonary disease (COPD) presents to the pulmonary clinic for a routine evaluation. The patient reports mild dyspnea on exertion but denies any recent exacerbations or infections. He lives independently and uses oxygen at night.   Vitals (on room air): Vital Signs   Heart Rate (HR)  92 bpm Respiratory Rate (RR)  20 breaths/min Blood Pressure (BP)  135/85 mmHg SpO₂ on Room Air  88% BMI  27 kg/m²   Laboratory Results: Lab Test Result Hemoglobin (Hgb) 17.5 g/dL Hematocrit (Hct) 52% White Blood Cell Count (WBC) 8.5 × 10⁹/L Sodium (Na⁺) 138 mEq/L Potassium (K⁺) 4.0 mEq/L Chloride (Cl⁻) 96 mEq/L Creatinine 0.9 mg/dL   Arterial Blood Gas (ABG) Analysis (on room air): Parameter Result pH 7.40 PaCO₂ 57 mm Hg PaO₂ 42 mm Hg HCO₃⁻ 35 mEq/L Base Excess +8 mEq/L SaO₂ 77%   Based upon the clinical presentation, which of the following is the most appropriate next step in the management of this patient?

A 61-year-old male with a 30-pack-year smoking history and a…

A 61-year-old male with a 30-pack-year smoking history and a 10-year diagnosis of chronic obstructive pulmonary disease (COPD) presents to the pulmonary clinic for a routine evaluation. The patient reports mild dyspnea on exertion but denies any recent exacerbations or infections. He lives independently and uses oxygen at night.   Vitals (on room air): Vital Signs   Heart Rate (HR)  92 bpm Respiratory Rate (RR)  20 breaths/min Blood Pressure (BP)  135/85 mmHg SpO₂ on Room Air  88% BMI  27 kg/m²   Laboratory Results: Lab Test Result Hemoglobin (Hgb) 17.5 g/dL Hematocrit (Hct) 52% White Blood Cell Count (WBC) 8.5 × 10⁹/L Sodium (Na⁺) 138 mEq/L Potassium (K⁺) 4.0 mEq/L Chloride (Cl⁻) 96 mEq/L Creatinine 0.9 mg/dL   Arterial Blood Gas (ABG) Analysis (on room air): Parameter Result pH 7.40 PaCO₂ 57 mm Hg PaO₂ 42 mm Hg HCO₃⁻ 35 mEq/L Base Excess +8 mEq/L SaO₂ 77%   Based upon the clinical presentation, which of the following is the most appropriate next step in the management of this patient?