MRCP2-2500

MRCP2-2500

A 25 year old male of Nigerian descent presents to the ED with acute shortness of breath, fever, and dry cough. He reports that he can only tolerate exercise for about 10 yards due to his shortness of breath and is experiencing severe right-sided chest pain. The patient has a history of sickle cell anemia but has not been hospitalized in the past 2 years.

Vital signs:
– Heart rate: 94 bpm regular
– Blood pressure: 112/74 mmHg
– Temperature: 38.3°C
– Respiratory rate: 22 breaths per minute
– Urine output: under 30 ml/hr
– Oxygen saturations: 93% on room air

Physical examination reveals shallow breathing, bronchial breath sounds, and crepitations to the right base of the respiratory system.

Lab results:
– Hemoglobin: 7.7 g/dL
– Platelets: 200 * 10^9/L
– White blood cells: 13.2 * 10^9/L
– Bilirubin: 36 µmol/L
– Urea: 8.2 mmol/L
– Creatinine: 146 µmol/L

What is the most crucial initial step in managing this patient’s condition?