An elderly male with a history of metastatic non-small cell lung cancer, CAD s/p CABG and ischemic cardiomyopathy s/p an AICD is brought in by EMS following a fall down some stairs. He reports feeling very lightheaded as he was going up the stairs and then falling backwards before blacking out.

His vital signs on ED arrival are T 36.7˚C P 138 R 25 BP 106/56SpO2 95% on 4L NC. An ECG demonstrates sinus tachycardia. A CXR is obtained and the results are shown below.