4. Poor inspiratory effort


Poor inspiratory effort often makes the lung bases appear to have an infiltrate. Although her heart silhouette approaches 50% of the chest diameter on PA film, this is hard to interpret for a less than full breath. With a full expansion, the silhouette would be less than 50% of the chest diameter. Her lungs are clearly not hyperexpanded.

A couple hours later, she becomes increasingly obtunded and is hypotensive.

She is transferred to the MICU and emergently intubated. Her pre-intubation ABG showed hypoventilation with pH 7.19, pCO2 59 mm Hg, pO2 210 mm Hg on 4 Lpm oxygen.

What further testing is indicated?

  1. Blood cultures
  2. Brain naturetic peptide (BNP)
  3. Echocardiogram
  4. Thyroid function testing
  5. All of the above

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