While recovering from an extensive bowel resection, a 76-year-old man requires blood product replacement due to a postoperative hemoglobin of . His past medical history is notable for ischemic cardiomyopathy with a baseline ejection fraction of . Approximately one hour after the second unit of packed red blood cells is initiated, the nursing staff urgently calls the physician to the bedside. The patient reports sudden, severe shortness of breath and a pounding headache. Vital signs are temperature (), blood pressure , heart rate , and respiratory rate . Oxygen saturation is on room air. Physical examination reveals prominently distended neck veins while sitting upright. Auscultation of the lungs demonstrates diffuse crackles up to the mid-lung fields bilaterally. A third heart sound () is present. The transfusion is immediately halted and supplemental oxygen is provided. Which of the following is the most appropriate next step in the management of this patient?
- Administer intravenous furosemideAnswer
- BAdminister inhaled albuterol and systemic corticosteroids
- CObtain a computed tomography pulmonary angiogram
- DInitiate empiric broad-spectrum intravenous antibiotics
- ESubmit a punitive incident report against the nursing staff for an infusion rate error