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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?

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: