19th February 2025

You are called to review a 52-year-old lady on the ward due to an increasing oxygen requirement.

You are called to review a 52-year-old lady on the ward due to an increasing oxygen requirement. She was admitted a few days ago with a decompensation in her heart failure and is currently on an IV furosemide infusion of 120 mg over 24 hours. You review the notes and see that her oxygen requirement has been slowly increasing over the last few days and note that her weight, when measured daily, has only decreased by 1kg.

Her observations currently show a heart rate of 113, blood pressure of 79/38, respiratory rate of 30 and saturations of 90% on 15 L/min. Examination reveals bibasal crepitations up to the midzone bilaterally with no wheeze, she has a high work of breathing and is slightly drowsy but responding to your questions. You perform an ABG which shows:

pH 7.467, pO2 7.1, pCO2 3.4, HCO3 22, BE +0.1, lactate 1.6

You initiate CPAP therapy on this lady at pressures of 5 cmH₂0 and her blood pressure drops to 65/31 with a heart rate of 130 and she becomes unconscious.

What would be your next step in the management of this patient?

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