A 28-year-old female with chronic R thigh pain due to diabetic myonecrosis is brought by her family to the ER with the chief complaint of progressive shortness of breath and somnolence. 

According to the patient’s family, she was well until about 24 hours prior to presentation, when she began experiencing increasing shortness of breath. Due to pain, she is relatively immobile at home but does move around the home intermittently with assistance. 

The family denies any recent ill exposures, recent travel, chemical exposures/ingestions, or witnessed aspirations. The patient has not complained of fever or cough in the past 24 hours and has been taking her pain medications exactly as prescribed. 

The pain medication regimen has not been changed in more than three months. The patient has no underlying lung disease and is a nonsmoker. 

Vitals: 96.8, HR 132 and regular, BP 112/59, R 48 and labored with accessory respiratory muscle use, Pox 96% on RA. 

Patient is lethargic and difficult to arouse but does awaken to both verbal and tactile stimuli for brief periods. 

Remainder of examination, including lung examination, is unremarkable. 

CBC and chem 7 are essentially unremarkable.  ABG on RA: 7.71/15/123/20/97%. CXR, lower extremity doppler ultrasonography, and Chest CT angiography are all unremarkable.

Based on the information provided, what is the most accurate documentation for this patient’s primary diagnosis? Click the best answer.