Soru

A $74$-year-old female is evaluated in the emergency department for severe shortness of breath, confusion, and lethargy that has progressively worsened over the past $48$ hours. The patient has a known medical history of ischemic cardiomyopathy with a left ventricular ejection fraction of $20\%$, chronic kidney disease stage $3$, and type $2$ diabetes mellitus. Her home medications include sacubitril-valsartan, carvedilol, spironolactone, empagliflozin, and aspirin.

Upon arrival, she is difficult to arouse but oriented to person only. Her extremities are cool and mottled, with weak distal pulses and delayed capillary refill. Jugular venous distention is prominent, estimated at $12$ cm $H_2O$. Auscultation of the lungs reveals diffuse bilateral crackles extending to the apices. Cardiac examination reveals tachycardia with a regular rhythm and a distinct $S_3$ gallop.

Initial vital signs are:
Blood pressure: $78/52$ mm Hg
Heart rate: $118$/min
Respiratory rate: $28$/min
Oxygen saturation: $84\%$ on room air

Point-of-care laboratory testing reveals:
Serum creatinine: $3.4$ mg/dL (baseline $1.6$ mg/dL)
Serum potassium: $5.4$ mEq/L
Venous lactate: $5.2$ mmol/L

The patient is immediately placed on noninvasive positive pressure ventilation. The physician is preparing the initial pharmacologic management plan.

Which of the following interventions are appropriate for this patient at this time? (Select all that apply)