Pulmonary: Respiratory Failure CC: Respiratory failure. HPI: The patient is an xx-year-old male presenting to the clinic to the clinic for respiratory failure. According to EMS, he has a history of COPD secondary to smoking, which got abruptly worse today. Family is not present with the patient today. We were unable to get a history from the patient secondary to his condition. ROS: No ROS secondary to condition. PE: General: He was diaphoretic and tripoding and in extreme respiratory distress. Lungs: He was using accessory muscles, and had diminished breath sounds throughout the lung fields and scattered rhonchi, increased respiratory phase. Heart: Distant heart sounds, tachycardic. Bilateral pulses symmetric. Extremities: Trace lower extremity edema. Abdomen: Soft. EKG: The EKG revealed an artefact. The reading was essentially unchanged from March 15, 2012. There was sinus tachycardia, right bundle branch block, some occasional PACs, nonspecific ST-T changes in the lateral leads. AP: Portable chest x-ray for tube placement and EKG. Ordered ABG. CBC, BMP, PT, INR, LFT, BNP, and troponin. He was started on a propofol drip. ER Course: The patient was started on BiPAP, RSI, 15 mg etomidate IV, succinylcholine 100 mg, and intubated. He is stabilized in the ER. He will be admitted to the hospital.
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