Your 57-year-old patient is tripodding and complaining of re…

Your 57-year-old patient is tripodding and complaining of respiratory distress. She is only able to speak 1-2 words without having to take a breath. She has a history of chronic bronchitis, CHF, pneumonia, hypertension, and GERD. Her medications include Flovent, Albuterol, prednisone, HCTZ, atenolol, lisinopril, and ranitidine. Physical exam reveals diminished breath sounds bilaterally and significant accessory muscle use. Vitals are BP 156/94, P 124, R 44, and SpO2 of 86% on room air. A snapshot of her capnogram is shown below.   You suspect