Accompanied by her husband, a -year-old woman arrives at the emergency department experiencing acute-onset breathlessness and a persistent cough. Her symptoms began rapidly over the past hours. She has a medical history notable for type diabetes mellitus and refractory major depressive disorder. Her daily medications include metformin and phenelzine. Three days ago, she developed a mild upper respiratory tract infection and began taking an over-the-counter oral decongestant containing pseudoephedrine.
On arrival, the patient is visibly distressed, diaphoretic, and speaking in short phrases. Her temperature is (), blood pressure is mmHg, pulse is /min, and respiratory rate is /min. Pulse oximetry demonstrates an oxygen saturation of on room air. Physical examination reveals prominent jugular venous distention. Cardiac auscultation shows a regular tachycardia with a loud gallop and no discernible murmurs. Pulmonary auscultation reveals diffuse, fine inspiratory crackles bilaterally, extending up to the mid-lung fields. Bilateral trace pedal edema is present.
Which of the following is the most appropriate next step in the management of this patient?
- Initiate intravenous nitroglycerin and torsemideCevap
- BAdminister nebulized ipratropium and oral glucocorticoids
- CDiscontinue phenelzine and immediately initiate oral citalopram
- DStart empirical therapy with intravenous meropenem and vancomycin
- EAdminister a continuous intravenous infusion of sodium bicarbonate