19th February 2025

An 89-year-old woman presents overnight from a care home with acute delirium and breathlessness.

An 89-year-old woman presents overnight from a care home with acute delirium and breathlessness. She has a background of ovarian cancer, which is being managed palliatively, severe clinical frailty and advanced dementia.

She is saturating 95% on 60% FiO2 venturi mask, a heart rate of 140 bpm and a blood pressure of 86/43 mmHg. She receives 2 fluid boluses of 250 mL of Hartmann’s solution and her subsequent blood pressure is 85/45 mmHg. She has ongoing oliguria and rising lactate.

Her CTPA shows the following:

What is the most appropriate next step to take?

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