Your patient is a 79-year-old female who presents in moderat…

Your patient is a 79-year-old female who presents in moderate respiratory distress. She sits upright and can answer your questions with only short phrases. She complains of a recent cold and worsening shortness-of-breath and cough. She denies chest pain. She has a long history of breathing problems. She admits to being a 2-pack-per-day smoker for the last 50 years. Vital signs are BP 150/80, P 100, and R 36 and labored. Her skin is cyanotic and you auscultate diffuse expiratory wheezes. She has a productive cough with yellowish-brown sputum. You suspect