You have a patient with severe multiple sclerosis that is advanced and progressive who now develops renal failure secondary to diabetes. The patient is alert and has elected to put the DNR (Do-Not-Resuscitate) order in place at her own discretion. The patient's potassium level is now markedly elevated at $8 \mathrm{meq} / \mathrm{L}$. Which of the following is the most appropriate management of this patient?

You have a patient with severe multiple sclerosis that is advanced and progressive who now develops renal failure secondary to diabetes. The patient is alert and has elected to put the DNR (Do-Not-Resuscitate) order in place at her own discretion. The patient's potassium level is now markedly elevated at $8 \mathrm{meq} / \mathrm{L}$. Which of the following is the most appropriate management of this patient?

A 27-year-old pregnant woman presents in her last trimester of pregnancy with severe cephalopelvic disproportion. Her physicians have recommended a caesarian section. She does not want to undergo the surgery. She fully understands the procedure and she is unwilling to suffer the discomfort of surgery. She has been informed that without the C-section her fetus may not survive childbirth. What should you do?

A 12-year-old girl presents with severe right lower-quadrant abdominal pain and marked tenderness and is found to have acute appendicitis. The child is at a sleep away camp. You are not able to locate her parents. They are not at home and you cannot reach them on the cell phone. The camp counselor and the director of the camp bring in the child. What should you do?

A 3-year-old presents to the emergency department. She was diagnosed with pyelonephritis by her physician yesterday, treated with an intramuscular injection of antibiotic and sent home on an oral antibiotic. She is vomiting today and unable to keep the antibiotic down. As you prepare to admit her, you feel she should have been admitted yesterday. Should you tell the parents that their physician made a mistake?

A 68-year-old man is brought to the hospital due to 2 days of progressive shortness of breath and cough. He has a history of severe chronic obstructive pulmonary disease and has had multiple recent exacerbations and several hospitalizations over the past year. During his last hospitalization, he had acute respiratory failure requiring endotracheal intubation. This prompted the patient to make a living will specifying that he does not want any resuscitative measures or invasive therapies in the event of a life-threatening emergency. On examination, he is lethargic and arousable only to noxious physical stimuli. His temperature is $37.2 \mathrm{C}(99 \mathrm{~F})$, blood pressure is $132 / 70 \mathrm{~mm} \mathrm{Hg}$, pulse is $102 / \mathrm{min}$, and respirations are $32 / \mathrm{min}$. Examination reveals diffusely decreased breath sounds, bilateral expiratory wheezes, and labored breathing. It is determined that he lacks decision-making capacity. His daughter says, 'I have been taking care of my father for many years and I know him better than anyone. He would not want any aggressive measures. Please just make him comfortable.' However, the patient's wife demands that everything be done to save her husband's life, including intubation if necessary. She insists that she knows what her husband would have wanted and threatens to file a lawsuit. Which of the following interventions is the most appropriate next step?