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EM@3AM: Transfusion Associated Circulatory Overload

A 67-year-old female with a history of CHF and CKD was brought in by ambulance from her nursing home for a gastrointestinal bleed. The patient’s total fluid balance from her nursing home was 2.5L over the past 24 hours. Her point of care hemoglobin is 4 g/dL and a transfusion of 2U pRBC and 1 FFP was initiated, though within approximately 1 hour of starting the transfusion, the patient became acutely short of breath and stated she was having severe difficulty breathing. What’s the next step in your evaluation and treatment?