The RT is called to evaluate a 55-year-old woman with acute respiratory distress and worsening…

The RT is called to evaluate a 55-year-old woman with acute
respiratory distress and worsening hypoxemia. The patient is 3 days
post-admission for right-sided rib fractures. This resulted from falling down a
flight of stairs, secondary to alcohol intoxication with brief loss of
consciousness. Since admission she had maintained adequate oxygenation with
pulse oximetry (SpO2) of 95% on 3 L/min of nasal O2. Over the past hour she has
become febrile (maximum temperature 39.5°C), tachycardic (heart rate 130
beats/min), and hypotensive (blood pressure 88/50 mm Hg; mean, 63 mm Hg), with
new-onset altered mental status. Her SpO2 is now 87% on 6 L/ min nasal O2 with
a respiratory rate of 32 breaths/min. Her medical history is significant for
alcoholism and a 30 pack-year smoking history. What can the physical
examination and history tell us about the potential source of respiratory
distress?

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