P 140, irreg.
R 30 and labored
General: Breathless, moderately obese male in acute distress sitting upright complaining "I am going to die. Please help me."
HEENT: Normocephalic. Eyes, ears, and throat normal.
Neck: Distended neck veins with visible cannon waves, JVD to 12cm. Carotids without bruits.
Chest: Scattered rhonchi throughout, rales bilateral one third lower bases. Cough is productive and frothy.
Heart: Tachycardia and irreg. Grade 3/6 systolic murmur at LSB, S3 gallop noted.
Abd: Liver palpable three centimeters below right costal margin. HJR+. Non-tender to palpation, +Bowel sounds 4 quadrants.
Genitalia: Exam deferred.
Extremities: 4+ pitting edema of lower extremities to the knees. Nail beds minimally cyanotic, no clubbing. Pulses intact.
Neurologic: Anxious with feeling of impending doom. No localized or sensory deficits. Mental status intact.
Na 130, K 3.8, HCO3 20. BUN 18. Cr 1.0.
ABG's on room air: pH 7.30, PaO2 55, PaCO2 28.
EKG: Left bundle branch block. Atrial fibrillation with ventricular rate of 140.
CXR: Cardiomegaly with diffuse pulmonary infiltrate consistent with pulmonary edema.