A 79-year-old woman is brought to the emergency department after collapsing at the dinner table. She has had 3 days of left flank pain, fever, and repeated vomiting and has been unable to keep down oral fluids. Four days ago, CT at another hospital showed an 8 mm left proximal ureteral stone with hydronephrosis, and she was discharged on ibuprofen and tamsulosin. She has no known drug allergies. On examination she appears unwell and has marked left costovertebral angle tenderness. Laboratory results: WBC 22.4 x 10^9/L (4.0-11.0), creatinine 245 µmol/L (45-90; baseline 78), lactate 3.8 mmol/L (0.5-2.0). Urinalysis is positive for nitrites and leukocyte esterase.
| Heart rate | 122/min |
| Respiratory rate | 26/min |
| Temperature | 39.4 °C |
| O2 saturation | 94%, room air |
| Blood pressure | 86/50 mm Hg |
Question 1 of 30
Which of the following are the most appropriate next steps in management?
Select 3. (0 / 3 selected)
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