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A 72-year-old female with history of Parkinson disease and diabetes presents to the emergency department (ED) complaining of nausea, vomiting, and abdominal pain. A CT scan revealed a small bowel obstruction secondary to a twist in the mesentery. She subsequently was intubated for exploratory laparotomy and lysis of adhesions. She continued to fail daily spontaneous breathing trials for the last 3 days. The chest radiograph below is the morning post breathing trial failure: CXR2.jpg What is the next step?

A 67-year-old-male with bullous emphysema is scheduled for a bullectomy to prevent air-leak syndrome. The AG-ACNP knows which of the following patients would not be suited for a bullectomy:

A 48-year-old male with no prior medical history is admitted with community-acquired pneumonia and severe acute respiratory distress syndrome (ARDS). On day 1 of his illness, he is admitted to your ICU on volume control-assist control ventilation with a VT of 4 mL/kg IBW, respiratory rate 32 breaths per minute, PEEP 14 cm H2O, and FiO2 1.0. On those settings, he is found to be hypoxemic with a SaO2 of 86% with an ABG that demonstrates pH 7.28 PCO2 65 mm Hg and PaO2 55 mm Hg. Which of the following interventions is most likely to improve his survival?

An 84-year-old male with severe chronic obstructive pulmonary disease (FEV1 20% predicted, on 4 L/min home O2) is admitted with severe hypoxemic respiratory failure due to a Streptococcus pneumoniae infection. He is intubated and placed on volume control-assist control ventilation with a set TV of 400 mL (6.5 mL/kg IBW), PEEP of 8 cm H2O and a respiratory rate of 30 breaths per minute. When the paralytic used for intubation wears off, the patient is noted to be triggering additional spontaneous breaths with a total respiratory rate of 36 breaths per minute, and his exhaled TVs vary from 100 to 800 mL. During an end-expiratory pause, his airway pressure is 18 cm H2O. Which of the following is the MOST accurate statement regarding his ventilator settings?

A 42-year-old obese female with OSA, diabetes mellitus, and hypertension is admitted for community-acquired pneumonia. After multiple attempts, she is emergently intubated with ET tube size 8.5. She has been intubated for 7 days and today she has tolerated the spontaneous breathing trial. What is the next step?

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?