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?

Which of the following chronic medical therapies are shown to improve survival in patients with COPD? Smoking cessation in combination with:

A 56-year-old male with a 30-pack-year smoking history, COPD, and peripheral vascular disease is admitted for right femoral popliteal bypass. Anesthesia has attempted to extubate him but he subsequently developed shortness of breath and hypoxia. Nebulizers, corticosteroids, and NIPPV are applied. Two hours later, the patient has increased work of breathing, and his oxygen saturation would intermittently drop to the 70s. His chest radiograph has shown a persistent infiltrate on the right lower lobe. On the second day, the chest radiograph shows no acute pulmonary disease. The patient is being liberated from the mechanical ventilator. What should be considered?

You assess a 55-year-old male patient who is a candidate for bariatric surgery. He is 175 cm, 120 kg and has arterial hypertension for which he takes ramipril. His wife tells you the patient snores during the night. His blood pressure (BP) is 125/75 mm Hg and pulse oximetry is 89% on room air. What is the MOST appropriate management of this patient?

A 65-year-old male with a history of COPD and active tobacco use with no prior intubations presented to the emergency department with increased work of breathing and increased wheezing. In the emergency department, he was given stacked nebulizers and IV steroids and initiated on BIPAP. His initial blood gas demonstrated pH 7.2/ pCO2 75/ pO2 65. Following intubation, he was placed on volume control ventilation. His initial peak pressure (peak inspiratory pressure [PIP]) was 45 cm H2O, and his plateau pressure (Pplat) was 35 cm H2O. He was placed on a respiratory rate of 30, PEEP 15, FiO2 0.40 and his SpO2 was 90%. Two hours after arrival to the ICU, his ventilator starts to alarm for high pressures. His peak pressures have increased to 65 cm H2O, and his plateau pressure has increased to 55 cm H2O. His heart rate increases from 80 beats per minutes to 110, and his blood pressure drops from 110/70 to 80/50 mm Hg. His SpO2 drops to 75%. His examination is notable for continual wheezing and slight deviation of the trachea toward the left.What is the most likely cause for this acute change?