Review Question - QID 213902

A 57-year-old woman with a history of IV drug use and alcoholism presents to the emergency department after a fall. She was carrying a tray of cat food for her cats when she tripped over one of them, falling onto her side. Since the fall, she is complaining of significant pain in her right chest. Her temperature is 98.3°F (36.8°C), blood pressure is 147/85 mmHg, pulse is 88/min, respirations are 14/min, and oxygen saturation is 94% on room air. An initial ECG is notable for sinus rhythm. A chest radiograph is performed as seen in Figure A. The patient is ultimately discharged with ibuprofen, oxycodone, acetaminophen, and lidocaine patches. She returns 2 days later complaining of worsening pain. Initial laboratory studies are pending, and a venous blood gas is performed as seen below.

pH: 7.25
pCO2: 61 mmHg
HCO3: 26 mEq/L
PO2: 94 mmHg

Which of the following is the most appropriate treatment for this patient?