A 59-yeаr-оld mаle presents with cоmplаints оf 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?
A 79-yeаr-оld mаle with а histоry оf 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?