A 65 year old female presents to your ER with difficulty breathing over the past 3 days, despite increasing her home oxygen tank to 3 liters. Her husband called 9-11 because she wasn't really acting herself.  EMS arrived and found her sats in the 70s and put her on a non-rebreather mask and had an improvement in her sats to the low 90s. They also reported some wheezing on exam, so they gave her one duoneb prior to arrival.  Per EMS she has a past medical history of COPD (on 3 liters around the clock), CHF with an EF of 40%, hypertension, hyperlipidemia, and type II DM. So, you walk into the hospital room and the first thing you notice is that the patient appears to be in respiratory distress. Shes' wearing a nasal canula which is set to 5 liters. She's breathing fast (belly breathing), her sternocleidomastoids are going to town, she has accessory muscle use. Her sats are at 82% with good wave form on the monitor. Heart rate is in the 80s. Systolic BP of 150. She's able to tell you her name and her story - but she's definitely having difficulty speaking due to the respiratory distress.  You listen to her lungs and she's wheezing, but also hear some crackles at the base.  What would you do? Today, we'll show you what to do next, so you don't freeze up should this patient ever walk into your hospital... - Subscribe to our YouTube here: https://www.youtube.com/medgeeks - Follow us on Instagram here: https://www.instagram.com/medgeeksinc - Ace your exams: https://learn.medgeeks.co/ - We'd love to hear your feedback: team@medgeeks.co - This podcast should not be used in any legal capacity whatsoever, including but not limited to establishing standard of care in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the podcast, video, or blog.