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13644 Radiology

A 64-year-old woman is admitted to the ICU with the clinical diagnosis of acute respiratory distress syndrome (ARDS) secondary to pneumonia. She requires intubation and mechanical ventilation. On the second ICU day, she is difficult to ventilate, requiring increased airway pressures. On physical examination, vital signs are: pulse 159 bpm; temperature 100degF; blood pressure 90/56 mm Hg. Lung exam reveals diffuse crackles, and the patient has a palpable crunch on exam of her chest wall and abdomen. Chest radiograph is shown below.. What will you do next?

APlace a chest tube
BChange antibiotics
CPerform an open thoracotomy
DContinue management, minimizing volutrauma
Radiology
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