A 69-year old male is brought into your department in acute respiratory distress. He is breathing 56 times per minute, using all of his accessory muscles of respiration. His skin is cold and moist. His BP is 188/110, with sinus tachycardia at a rate of 152/minute. His S02 = 70% per pulse-oximeter. He has bilateral inspiratory crackles in all lung fields and his wife states he has been “battling heart failure” for several years.