22nd December 2021

A 68-year-old male patient presents to A&E with sudden acute flank pain and breathlessness when lying down

A 68-year-old male patient presents to A&E with sudden acute flank pain and breathlessness, especially when lying down. His only past medical history is of diabetes. Blood tests show he has developed an acute kidney injury (AKI), and he has minimal urine output. He is feeling increasingly short of breath, and you note widespread fine crackles on auscultation. His oxygen saturations are measured at 92% (no known history of CO2 retention) – which is corrected with low-flow oxygen. What would be your immediate management?

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