A 63-year-old man was hospitalized 24 hours ago for acute myocardial infarction. He is found obtunded in his bed by the nursing staff. His blood pressure is 82/56 mmHg and heart rate is 126 bpm. He is clutching his chest and appears dyspneic. Auscultation of his lungs reveals new onset rales.
What is the most appropriate initial intervention?
A. Vasopressors
B. Fluid bolus and reevaluation
C. BiPAP and nitroglycerin
D. Immediate physician referral
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