IMPRESSION:
In comparison with the study  , there has been placement of an
 endotracheal tube with its tip approximately 4.6 cm above the carina.
 Nasogastric tube extends to the lower body of the stomach.
 
 Continued low lung volumes.  There is increase in the size and indistinctness
 of pulmonary vessels, consistent with elevated pulmonary venous pressure
 possibly related to over-hydration.
 
 The 3-channel pacer device remains in place.  The left IJ catheter again
 crosses the midline to extend to the right subclavian or internal jugular
 system.