 You are working in the emergency department today. Your next patient is a 65-year-female who's brought in by a family due to severe shortness of breath. On arrival, she is sitting upright. Her vital signs include blood pressure of 180 over 90, heart rate of 120, rest rate of 34, and oxygen saturation of 80% on remair. Your nurse quickly put her into a monitor bed. They also put 100% oxygen on her by non-rebreather. They quickly establishes two large HIV. When you speak to the patient's family, they describe the patient has been having one week of increasing shortness of breath and leg swelling. In terms of a shortness of breath, it is worse when she lies down and when she exerts herself. Because of the shortness of breath when she lies down, the patient has been needing two to three pillows to sleep. She has not travel anywhere. She does not have fever or cough. In terms of her previous history, she has a history of a myocardial infarction five years ago and a history of congestive heart failure. This morning, her shortness of breath got worse and she started having pink frothy sputum. That is when they decided to bring her to the emergency department. You go to examine the patient. Her oxygen saturation is now 85 to 87% on 100% oxygen. She's still sitting upright and she has tracheotugging and intercostal in-drawing. She's only able to speak one word at a time. Her JVP is 8 centimeters. She has bilateral crackles up to her apices. She has bilateral 3 plus pitting edema up to her knees. You ask for a 12-lead ECG, which is normal. You also call for a portable chest x-ray. It confirms your diagnosis that the patient is having a severe CHF exacerbation. You call for the respiratory therapist to start the patient on a biped machine. You ask the nurse to start the patient on a natural glycerin infusion. You also ask for routine blood work. After about half an hour, the patient indicates that she's starting to feel a little bit better. Her respiratory rate has come down. She's able to explain that she has missed one week's worth of a water pill. She has gained about 10 pounds this week on her own scale. You ask the nurse to give the patient some ferosimide. After two hours, the patient is able to come off the biped machine and maintain her oxygen on only four liters of oxygen by nasal prongs. She had direased about 750 cc of urine. You now consult the inpatient team to take over the care of this patient.