Interesting call case.
64 yo male. Presents to ER with vomiting, abd. distention, anorexia. Pneumatosis on CT, c/w Small bowel obstruction. Plan to go to OR for Exploratory Lap and Illiostomy.
PMH:NPO > 12 hours. No hx CAD or lung disease, non smoker. Hx of pheochromocytoma s/p adrenalectomy in 1992. Now has a recently dx. new secreting tumor. Poor historian, difficult to differentiate what meds he is on at home.
Report from ER: CXR is "whited out", O2 sats 90% on 4L NC. Appears comfortable. 18g IV x1. HR 122, NIBP 225/115. Nothing exciting about the lab work. Hct 39

How to procede. As a caveat. It's 2330 in a community hospital. Take that for what it's worth.

Note: Unlike some of these case studies that are kind of a "choose your own adventure" to some doomsday scenario, I will disclose the case went off without a hitch. I'm more interested in seeing how other people would manage this case as it was a first for me.