In the ED, their vitals/exam are above. Patient with hypoxemic respiratory failure in the setting of ***.
– Labs/Tests: VBG plus, Lactate, CBC, CMP, Lipase, Trops x2, BNP, Procalcitonin, PT/INR, BCxs, UA w/ reflex UCx, SCx, COVID-19 RT PCR, Influenza A/B, RSV, Urine Strep pneumo and Legionella. Low threshold for COVID risk stratification labs if suspicious for COVID-19 RT PCR.
– Imaging: BSUS, Portable CXR, Low threshold for CTPE
– Treatments:
#Neuro: Sedation for vent sync w/ propofol gtt +/- dilaudid/fentanyl gtt
#Resp: ARDSNet ventilation (Vt 4-6cc/kg of ideal body weight, Pplat for goal <30, driving pressure [Pplat - PEEP] for goal <15, target SaO2 90-95%, target PaO2 >60) until PEEP <10 #CV: If pressors needed, levophed gtt -> vasopressin if levophed gtt >10
#Renal: Attentive fluid management for goal TBB even to -500cc 
#ID: Acetaminophen PRN for fever reduction, Low threshold for antibiotics including (Vancomycin 20mg/kg x1, Ceftriaxone 1g x1 [Cefepime 2g x1 if concerned for MDRO], Doxycycline 100mg x1)
#TLD: Place radial arterial line, left internal jugular triple lumen catheter, urinary foley cathter
– Consults: ***
– Dispo: Likely admission to ICU