A 54-year-old male patient arrives in the emergency department complaining of severe chest pain that radiates to his mid-back along with dyspnea. He is morbidly obese, has smoked two packs of cigarettes a day for the past 20 years, and has two immediate family members who have died of heart disease. 1. What does the ED physician suspect is causing the patient’s symptoms?

2. What tests should the ED physician order?

3. Will surgical intervention be necessary, and if so, what procedure?

4. What procedure is typically attempted before surgery, where is that procedure performed, and by what type of physician specialist?

A92-year-old man with a 45-year history of chronic obstructive pulmonary disease is intubated in the icu because of a bout of viral pneumonia that fails to improve after 72 hours of antibiotics. although the inspired fraction of oxygen is 100%, the patient's po2 remains at 57 mmhg. positive-end expiratory pressure (peep) is added to allow the inspired fraction of oxygen. twelve hours after the introduction of peep the patient suddenly become hypotensive. at the same time, his oxygen saturation drops from 92% to 61%. on physical examination, his bp is 80/50 mmhg and his pulse is 124/min. he has distended neck veins and distant heart sounds. which of the following would also most likely be seen on this patient's physical examination? - absence of breath sounds in the right hemithorax- high amplitude carotid artery upstroke- a pleural friction rub- pulsus alternans- splenomegaly