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Mary Juana, a 22-yr-old female, was brought by ambulance to the emergency department of a trauma center after being rescued from a burning building. She suffered second and third degree burns on her face and chest. The investigation reports that it appeared that her apartment caught on fire starting in the bedroom. The extent of her third degree burns was 22% of her total body surface area (TBSA). The patient was placed on oxygen, given fluid, and the wounds were cared for by the nurse. 48 hours after admission to the intensive care unit, the patient's condition worsened. She developed a productive cough and worsening shortness of breath. Auscultation revealed bilateral fine and course crackles, and expiratory wheezing. The patient's vital signs were taken and an arterial blood gas (ABG) was obtained with the following results: Heart rate of 130 bpm, respiratory rate 32 bpm, ABGs on 40% high flow nasal cannula show a pH of 7.59, PaCO2 22 mmHg, PaO2 41 mmHg, HCO-3 20 mEq, and BE -4. A chest radiograph (CXR) showed bilaterally diffuse fluffy infiltrates and patchy opacities throughout the lungs. What other diagnostic tools would you recommend for this patient?
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