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?

A 56-year-old male with advanced idiopathic pulmonary fibros…

A 56-year-old male with advanced idiopathic pulmonary fibrosis presents to the ICU in respiratory distress. He is put on high flow nasal cannula with 50 L flow, 80% FiO2. ABG obtained has a pH significant for 7.32, PaO2 of 80 mm Hg, PaCO2 of 20 mm Hg, HCO3 of 30. Given his underlying disease, what is the primary physiological aberration leading to the patient’s hypoxemia?

A 36-year-old man is admitted for alcohol withdrawal. The pa…

A 36-year-old man is admitted for alcohol withdrawal. The patient is initially treated with lorazepam injection as needed based on the Clinical Institute Withdrawal Assessment (CIWA) scale but develops respiratory depression, requiring transfer to the ICU and mechanical ventilation. To treat the symptoms of withdrawal, the patient was started on fentanyl infusion, midazolam infusion, and propofol infusion. Attempts to lower the sedation were met with extreme agitation and dyssynchrony with the ventilator. After 5 days, dexmedetomidine was introduced. A few hours later, the patient became bradycardic and hypotensive. A crystalloid bolus was started. The electrocardiogram (ECG) shows a second degree heart block. Laboratory analysis shows the following: Labs1.jpgAdditionally, his serum osmolality gap is elevated. Which is the responsible medication for the abnormal laboratory values?

A 65-year-old female is scheduled for spinal surgery. She ha…

A 65-year-old female is scheduled for spinal surgery. She has a past medical history of CAD and HTN, atrial fibrillation. Her pre-op CXR is shown below. CXR4.jpg Which of the following is most helpful in predicting her risk of postoperative of respiratory failure?