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An elderly patient with septic shock from a urinary source is admitted into the ICU. The physical exam findings are suggestive of a fluid depleted state. Microbiologic cultures are obtained and antibiotics are initiated. A central line is placed, and CVP is measured at 6 mmHg.  What is the optimal next best step?

A 56-year-old male presents to the ED with substernal chest pain, pain with inspiration, systolic apical murmur, and fever. His ECG demonstrates ST segment elevation in all leads.  This should be recognized as:

Which of the following is true regarding symptomatic bradycardia?

A patient presents to the hospital for elective abdominal aortic aneurysm (AAA) repair. Which of the patients would MOST likely benefit from surgical intervention?

A 56-year-old male with 30-pack year smoking history, CAD, and advanced liver disease due to alcoholic cirrhosis is being evaluated for a liver transplantation. He complains of worsening shortness of breath. His heart rate is 110/min, blood pressure is 97/64 mm Hg, respiratory rate is 32/min, and saturation 90% on 5 L/min nasal cannula. When asked to sit up in bed, the patient states that he “usually breathes better” when lying supine.  Which of the following is the MOST likely pathophysiology behind the diagnosis?

A 65-year-old female with hypertension and hyperlipidemia develops substernal chest pressure with dyspnea. Physical exam is notable for the following: Blood pressure: 126/62 mm Hg, pulse: 76 beats per minute, oxygen saturation of 97% on 4 L nasal cannula General: Sitting up with increased work of breathing Heart: Regular rate and rhythm. A III/VI holosystolic murmur is heard at the cardiac apex, which is nondisplaced on chest palpation Lung: Posterior diffuse crackles Abdomen: Soft, nontender, and nondistended Extremities: Warm, without edema 12-lead electrocardiogram reveals the following: ECG9.jpg What is the most likely mechanism of this patient’s dyspnea?

A 50-year-old-female with history of COPD and anxiety disorder is admitted and intubated for acute hypoxic and hypercapnic respiratory failure from COPD exacerbation secondary to community acquired pneumonia. Despite being on fentanyl and propofol, she is able to open her eyes to voice and tactile stimuli. She subsequently appears to become anxious but she is not dysynchronous with the ventilator. What is her RASS score?

A 53-year-old morbidly obese male with a history of HTN, DM, and HFpEF presents to the ED with shortness of breath. His vital signs show a HR of 98, BP of 186/94, RR of 22, and O2 sat of 94% on RA. Initial labs are ordered including a B-type natriuretic peptide (BNP). Which of the following is true regarding BNP for this patient?

A patient is in the postanesthesia care unit immediately postop from a total hip replacement. The nurse calls saying the patient is progressively more somnolent but still arousable and has received a dose of fentanyl for severe pain. The AG-ACNP obtains the following ABG: pH 7.30, PaCO2 56, PaO2 68; HCO3 24; Sat 92%; BE 1. The next step the AG-ACNP order is:

A 45-year-old male with morbid obesity (BMI 55) presents to the ED at 6 AM with right leg pain, and cellulitis that has kept him awake all night. He is admitted to the ward and his fevers and skin examination are improved with antibiotics during the first 16 hours of hospitalization. At 2 AM you are called to evaluate the patient for ICU admission because of somnolence and hypoxemia (SpO2 falling to high 70s on 2LNC). The rapid response team had difficulty waking the patient and ABG was performed before your arrival in the patient’s room: 7.29/74/52. Following arterial puncture, the patient woke up and by your arrival he is able to converse but remains sleepy with eyes closed, denying dyspnea, with SpO2 now 92% on 2LNC, and normal work of breathing. Medication history was reviewed, and no opiates have been administered. The ward team is requesting ICU transfer because of acute hypercarbic respiratory failure and initiation of BiPAP. You review recent laboratory test results and note that serum bicarbonate has been 38 to 40 over the last 6 months.Which of the following statements is true?