Pt with PMH CHF OR Dialysis p/w acute SOB and hypoxemia. Respiratory distress ML 2/2 fluid overload. Unlikely PE, anaphylaxis, COPD. Potential concomitant PNA as patient febrile.

Acute intervention:    BiPap to assist effort of breathing and decrease BP, patient AAOx3. Consider NTG drip to lower BP if continues to rise: 5 mcg/minute, increase by 5 mcg/minute every 3 to 5 minutes to 20 mcg/minute. Lasix vs dialysis (+renal consult) to remove fluid burden.

Acute workup:
– BUS + B lines, +pulmonary edema
– CXR_______
– Likely HCAP–> Vanc + Zosyn
– VBG
– ECG, Troponin, BNP
– Infectious workup: UA, Bacterial blood culture x2, Lactate, PT/INR

Plan to admit to medicine