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A 22-year-old male is admitted to the intensive care unit after sustaining a cardiac arrest while playing soccer in a rural area. Cardiopulmonary resuscitation was performed, but no automatic external defibrillator was available; he was intubated in the field because of poor mental status. He is transferred to your tertiary care ICU. Examination reveals an ejection systolic murmur, and he followed commands when sedation was lightened. Transthoracic echocardiography reveals discrete upper septal hypertrophy measuring 18 mm and an elevated left ventricular outflow velocity. He successfully passes a spontaneous awakening trial and spontaneous breathing trial. Unfortunately, at that time, he develops atrial fibrillation, became hypotensive to blood pressures of 94/52, and FiO2 was increased from 0.4 to 0.6 in response to desaturations to the low 80s. The best treatment for this patient’s atrial fibrillation is:

A 24-year-old female presents to the ED with a complaint of, “My heart is pounding out of my chest and I’ve been short of breath for 4 hours.” She has had similar episodes, but all have spontaneously stopped. She is in good health and takes no medications. Her blood pressure is 120/80 mmHg and pulse too rapid to count. Her rhythm is shown in the following ECG. ECG2.jpg What is the most appropriate immediate management for this patient?

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?