A 26-year-old male presents to the ED with complaints of sho…

A 26-year-old male presents to the ED with complaints of shortness of breath and right-sided chest pain that began after a 2-mile run. The symptoms have been persistent for the past 3 hours. Pain is increased with inspiration. He denies any constitutional symptoms of fever, cough, chills, or sick contacts. He is an avid runner on a daily basis, but does smoke ½-pack of cigarettes per day. On physical exam he is tachypneic, with respiratory rate 30, 94% saturation on room air. Breath sounds are decreased in the left lung fields, and there is hyperresonance to percussion. The AG-ACNP obtains the following chest x-ray: CXR1.jpg What is the diagnosis?

A 26-year-old male presents to the ED with complaints of sho…

A 26-year-old male presents to the ED with complaints of shortness of breath and right-sided chest pain that began after a 2-mile run. The symptoms have been persistent for the past 3 hours. Pain is increased with inspiration. He denies any constitutional symptoms of fever, cough, chills, or sick contacts. He is an avid runner on a daily basis, but does smoke ½-pack of cigarettes per day. On physical exam he is tachypneic, with respiratory rate 30, 94% saturation on room air. Breath sounds are decreased in the left lung fields, and there is hyperresonance to percussion. The AG-ACNP obtains the following chest x-ray: CXR1.jpg What is the diagnosis?

A 42-year-old obese female with OSA, diabetes mellitus, and…

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?