Acute Caremiddle twist
A 68-year-old woman weighing 65 kg is in the emergency department with urinary sepsis. Intravenous antibiotics were given within 30 minutes of arrival and she has since had 2000 mL of sodium chloride 0.9%. Her blood pressure is 88/48 mmHg, heart rate 104/min, respiratory rate 22/min and oxygen saturation 94% on room air. Her jugular venous pulse is visible 4 cm above the sternal angle and there are new crackles at both lung bases. She has passed 20 mL of urine in the past hour. A repeat venous lactate is 3.9 mmol/L, unchanged from arrival. In the next fifteen minutes, which one of the following should be done first?