70 yo M W/COPD has SOB, dry cough&wheezing which started 6 hrs ago&worsened. Had 2 admissions this past yr for similar sx&both times also had A.fib w/RVR. Smoked 2 ppd daily for 40 yrs. ED started on Noninvasive Positive Pressure ventilation due to increased work of breathing. P 125, RR 24. Pulse ox 92% on 40% FiO2. exam diffuse wheezing thruout lung fields & prolonged expiration. Distant heart sounds & irregular. 1+ pretibial edema b/l. CXR hyperinflation. Treated w/IV corticosteroids & antibiotics&inhaled albuterol. Diltiazem infusion for a fib. 6 hrs later work of breathing improved & Transitioned to nasal cannula oxygen. On repeat exam, pt has bilateral face and neck swelling & palpation reveals creptius. Management?
a) Diuretic therapy
b) Immediate intubation
c) Angiotensin-converting enzyme inhibitor therapy
d) Emergent surgical intervention