Q. A 78-year-old male presents to the emergency department via ambulance. He is a resident at a long-term acute care (LTAC) facility, and was diagnosed six months ago with metastatic small cell lung cancer likely secondary to a 60 pack-year history of smoking. Paramedics report they were called because the patient developed hypotension earlier this afternoon, and staff at the facility were concerned because he was “very dehydrated” and had not eaten breakfast or lunch. There was reportedly no don’t resuscitate and/or do not intubate (DNR/DNI) orders on file. Intravenous (IV) access was established enroute to the hospital and the patient has thus far received approximately 200 ml of normal saline. On arrival, his blood pressure is 70/55 mm Hg, heart rate is 110/min, respiratory rate is 20/min, and his oxygen saturation is 88 percent on 2L of oxygen. Physical examination demonstrates dilated and bulging jugular veins bilaterally, muffled and distant heart sounds, and poor inspiratory and expiratory effort. Decreased breath sounds were noted in the right upper lobe. You order a STAT chest x-ray (see below) and electrocardiogram (EKG). Based on the information you have at this point in time, what is the most appropriate next step?