26th February 2025

A 39-year-old woman presents to the emergency department with breathlessness

A 39-year-old woman presents to the emergency department with breathlessness. She has recently been diagnosed with Hodgkin’s lymphoma but has not yet started treatment.

Her observations are as follows: heart rate 110 bpm, blood pressure 115/65 mmHg, respiratory rate 28, oxygen saturation 91% on room air, temperature 36.9 degrees Celsius. On examination, she is visibly breathless and her face appears very flushed. Her chest sounds clear to auscultation. On exposing her chest you note she has some venous distension in her upper chest. A plain chest radiograph shows significant mediastinal widening.

Other than giving oxygen, what is the most appropriate first step in the emergency management of this patient?

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