A 67-year-old diabetic patient on ESRD who missed dialysis presents with dyspnoea and crackles. What is the appropriate action?

In the scenario presented, the 67-year-old diabetic patient with end-stage renal disease (ESRD) who has missed dialysis is showing signs of dyspnoea and crackles in the lungs. These symptoms suggest fluid overload, which is a common complication in patients with ESRD, particularly if they miss dialysis sessions.

Using CPAP (Continuous Positive Airway Pressure) is a critical intervention in this case because it helps to improve oxygenation and relieve the work of breathing by increasing intrathoracic pressure. This can help to decrease the preload on the heart and facilitate the movement of fluid out of the lungs, thus improving respiratory distress.

The addition of nitroglycerin (nitro) can further assist in managing fluid overload by reducing blood pressure and decreasing cardiac workload, which is beneficial in cases of pulmonary edema. Calcium chloride is also administered in some emergency situations for its role in stabilizing cardiac activity, especially in patients who might require it.

While other options, like administering furosemide (which is a diuretic) or using an albuterol nebulizer (which is typically used for bronchospasm), may provide some benefit, they do not address the immediate respiratory distress as effectively as combining CPAP with nitroglycer