 You are working in the emergency department today. Your next patient is a 63 year old. She is brought in by a family member because of shortness of breath. According to the family member, this patient has a history of COPD. She had ran out of her puffers five days ago. Since then, she has become more short of breath and coughing more. She also noticed more sputum production. The family brought her in because she was much worse today. At triage, her vital signs as as follow. Tachycardia, tachypnea, hypertension, and low O2 sets. You put the patient on a cardiac monitor and give her oxygen by Venturi mask. Her set goes up to 90%. When you examine the patient, she is sitting upright on the side of the bed. She is still tachypneic at around 32. You notice she has pursed lip breathing, allowing for a slower exhalation of air. On her lung examination, you notice tracheotugging, an intercostal in-drawing. She has one word, dyspnea. You also hear diffuse wheezes. You ask the nurse to start her on salbutamol treatment and give her one dose of IVY hydrocortisone and a dose of antibiotics. You then page for a portable chest x-ray and the respiratory therapist. The chest x-ray did not show any pneumothorax or pneumonia. You ask the respiratory therapist to start her on bipap treatment. You ask the nurse to draw some blood work. After 30 minutes of being on the bipap machine, the patient starts to feel better. She has no tracheotugging, but she still has intercostal in-drawing. She is still tachypneic, but her respiratory has come down. Her lungs are still diffusely wheezy. You continue to manage her in the emergency department and plan to reassess her in another 30 minutes.