23rd May 2025

A 33-year-old female who has recently moved to the UK with no GP record, presented to ED acutely unwell.

A 33-year-old female who has recently moved to the UK with no GP record, presented to ED acutely unwell. History is limited due to a language barrier. She has SO2 96% on 15 L, bibasal crackles, BP 98/60, HR 120 bpm and showing fast AF on ECG. She has a temperature of 390c. Sepsis screen was sent off and CXR showed pulmonary oedema. Patient was resuscitated. Treatment for AF, pulmonary oedema and sepsis of unknown source was commenced. However, the patient showed limited response to management. On examination she had non-tender thyroid neck swelling. What additional management should be initiated as soon as possible?

Select the SINGLE most appropriate option from the list below. Select ONE option only.