A 76-year-old female undergoes uncomplicated coronary angiography via the right femoral artery for evaluation of a newly diagnosed cardiomyopathy. She is found to be without obstructive coronary artery disease. The patient is admitted to the intensive care unit for further monitoring. Her femoral angiogram is shown in the figure that follows. Angio2.jpg Two days following admission, the patient begins to cough. Shortly thereafter, she is observed to have sudden and rapid expansion of her right lower quadrant, with associated hypotension. Which of the following is the most appropriate next step?

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 patient is transferred to the ICU with a blood pressure of 90/60 mmHg, oxygen saturation of 85%, oliguria, and diffuse crackles. Pulmonary artery catheter readings reveal a cardiac output of 1.9 L/min. and a wedge pressure of 24 mmHg.  Which IV medication is appropriate to prescribe?

A 60-year-old male with a history of nonischemic dilated cardiomyopathy is admitted to the intensive care unit after presenting to the emergency department with several days of progressive dyspnea and lower-extremity swelling. He is found to be hypotensive and tachycardic and on examination is noted to be confused with edematous, cool extremities. A 12-lead ECG shows rapid atrial fibrillation with nonspecific ST-segment changes. His last transthoracic echocardiogram performed 1 year ago showed a severely dilated LV cavity with a left ventricular ejection fraction of 28%, severe mitral regurgitation, moderate aortic insufficiency, and severe tricuspid regurgitation.  In this patient, which of the following represents a contraindication to the use of an intra-aortic balloon pump (IABP)?

A 61-year-old male with history of ischemic cardiomyopathy and prior myocardial infarction is admitted to the ICU with symptoms of worsening shortness of breath and lower extremity edema. He has had cardiac resynchronization therapy with an implantable cardiac defibrillator (CRT-ICD) implanted 1 year ago. His home medications include carvedilol 12.5 mg twice a day, lisinopril 5 mg daily, aspirin 81 mg daily, spironolactone 25 mg daily, furosemide 40 mg daily, and atorvastatin 40 mg daily. On examination, he is afebrile, his heart rate (HR) is 60 beats/min, his blood pressure (BP) is 110/59 mmHg, his jugular venous pressure is elevated, his lungs are clear, he has a 3/6 holosystolic murmur with S3, and his lower extremities are cool with +2 pitting edema. Laboratory testing reveals sodium of 124 mmol/L, potassium of 4.6 mmol/L, blood urea nitrogen (BUN) of 51 mg/dL, and creatinine of 1.8 mg/dL. An ECG shows 100% atrioventricular paced rhythm.  Which of the following statements is FALSE with respect to this patient’s management?

An 83-year-old male who was on the telemetry unit for a heart failure exacerbation has been transferred to the intensive care unit due to new onset atrial fibrillation with a rapid ventricular response. He was given a diltiazem bolus followed by a continuous diltiazem infusion without successful rate control. It has been less than 48 hours and direct current cardioversion is being considered. The success of electrical cardioversion is inversely proportional to which of the following?

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?

An 81-year-old female with a history of HFrEF is admitted to the CCU for hemodynamic monitoring with a swan-ganz catheter. She is on a dobutamine infusion at 5 mcg/kg/min but continues to have poor cardiac output. In order to know if she would benefit from afterload reduction the SVR needs to be calculated. Calculation of the systemic vascular resistance (SVR) requires all of the following except?

A patient was mechanically vented for 7 days for community acquired pneumonia (CAP) and was extubated 2 days ago. His vitals and labs have been stable, but he failed the swallow evaluation by the speech therapist. What is the most appropriate intervention?

A 65-year-old male diagnosed with idiopathic pulmonary fibrosis a year ago not on supplemental oxygen therapy presents to the ED with a week and a half of worsening exercise tolerance, increased dry cough, myalgias, and subjective fevers. Over the last day he has been unable to walk across the room without resting. Physical examination is remarkable for SpO2 of 85% on 6 L NC with tachypnea and increased work of breathing, bibasilar crackles. Laboratory test results reveal WBC 10,000/ μL (slightly increased absolute neutrophil count), normal metabolic panel and liver function tests, troponin of 0.1 ng/mL, and BNP of 120 pg/mL. Rapid flu is negative, and PCR panel is pending. CXR shows worsening bilateral opacities, and results of CT scan are shown in the figure that follows. CT1.jpgThe patient is admitted to the ICU and placed on high flow nasal cannula at 40 LPM flow. Overnight FiO2 has ranged between 0.7 and 0.9 to maintain SpO2 in the low 90s, and he was unable to sleep because of dyspnea. On examination he appears to be tiring. Which of the following statements is true?