21st June 2026

A 53-year-old gentleman has presented to the emergency department with increasing shortness of breath.

A 53-year-old gentleman has presented to the emergency department with increasing shortness of breath. He has a past medical history of ischaemic heart disease and hypertension. He states that over the last few weeks, he has been waking up breathless and sleeping with three pillows as he cannot lie flat.

Observations in triage:

HR 95, BP 210/105, RR 18, Sats 89% RA, Temp 37.1c

Initial blood tests:

WCC 7, Hb 150, Na 130, K 4.5, Creat 89, CRP 5, Trop <5, BNP 3000

ECG: Normal sinus rhythmSpecific emergencies

CXR: Pulmonary oedema 

The patient is referred to the medical team for admission. What is the most appropriate management protocol for this patient?

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