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A 90-year-old female with a history of atrial fibrillation on Eliquis presents with right rib pain and dyspnea after a mechanical fall from standing. She is hemodynamically stable, but her chest CT reveals right rib fractures 3 to 5 with associated hemothorax. The next best step in management includes:

A 79-year-old male with a history of hypertension, dyslipidemia, and type-2 diabetes mellitus presents to the emergency department complaining of increasing shortness of breath, over the past 4 hours. Arterial blood gas (ABG) analysis at room air shows: PaO2 54 mm Hg, PaCO2 28 mm Hg, pH 7.48, HCO3 22 mEq/L. Upon admission, the patient is administered oxygen via a face mask with oxygen reservoir at 15 L/min. The SpO2 raises from 87% to 99%. Thirty minutes later, the patient is still dyspneic (respiratory rate: 32 breaths/min). Noninvasive blood pressure is 180/85 mm Hg, heart rate is 100 bpm. ABG now shows: PaO2 249 mm Hg, PaCO2 27 mm Hg. Chest auscultation reveals mild bilateral crackles at the bases of the lungs and mild wheezing. Body temperature is 36.2°C, WBC 6500/mL, creatinine 1.8 mg/dL, lactate 1.4 mmol/L. What is the MOST likely diagnosis?

A 59-year-old male presents with complaints of chest tightness and shortness of breath. He has a medical history of CAD, hypertension, and hyperlipidemia. Family history is positive for CAD, hypertension, hyperlipidemia, and asthma. His vital signs are: heart rate 110, blood pressure 189/106, respiratory rate 28, and SpO2 96%. On exam the AG-ACNP appreciates bilateral expiratory wheezes, but no rubs, gallops, or murmurs. Capillary refill time is less than 3 seconds. Which medication should be avoided until asthma has been ruled out?

The gold standard for the diagnosis of OSA-hypopnea syndrome is:

Neuromuscular blocking drugs may be beneficial in the management of a patient with ARDS because of which one of the following?

A 68-year-old woman with HIV is admitted to the ICU with respiratory failure secondary to pneumocystis pneumonia, requiring intubation and mechanical ventilation. A chest CT scan was performed before intubation and demonstrated cystic changes throughout the lungs, thought to be a sequela of past pneumocystis infection, with superimposed diffuse ground glass opacities. Her ventilator is set on volume assist-control, TV 6 mL/kg, respiratory rate 16 breaths per minute, FiO2 0.8, and PEEP of 10 cm H2O. On day 2 of her critical illness, her ventilator suddenly alarms for elevated peak pressures. She is observed to be deeply sedated and breathing passively on the ventilator. The peak pressure has risen from 25 cm H2O several hours before 50 cm H2O. The patient has simultaneously experienced oxygen desaturation from 95% to 90%. She is otherwise hemodynamically stable. A chest radiograph is ordered. An inspiratory hold maneuver is performed and her plateau pressure is 20 cm H2O. Which of the following is the MOST LIKELY explanation for this acute event?

The proper position for chest tube placement in a patient with a pneumothorax is:

36. Which food is high in monounsaturated fat?  

26. Which finding suggests severe malnutrition?  

A 38-year-old, 155 cm, 50 kg, previously health female presents to the ICU with altered mental status, tachycardia, hypotension, and high fever. She is intubated for airway protection. Her laboratory test results reveal a markedly elevated T3 and T4 level with a decrease in thyroid-stimulating hormone level consistent with thyroid storm. Her arterial blood gas shows a pH of 7.24, PaO2 of 80, PaCO2 of 52, and HCO3 of 22. Her ventilator settings are volume control, tidal volume of 350 mL, respiratory rate of 14, positive end expiratory pressure (PEEP) of 5, FiO2 of 50%. Which of the following is the next appropriate step in management?