Cheryl–Warra Allen, a 52 year old Aboriginal woman,

Cheryl–Warra Allen, a 52 year old Aboriginal woman, was brought into the emergency department (ED) by ambulance with acute shortness of breath. Cheryl has had previous ED admissions since relocating to Adelaide, from the remote Aboriginal community Poonindie, 3 years ago. Her previous medical history includes Type 2 Diabetes Mellitus (T2DM), Hypertension, and end-stage kidney disease (ESKD) for which she has hemodialysis treatment 3 times per week. Cheryl says that she has missed dialysis this week due to unforeseen family reasons and her blister pack of medications show that Cheryl had not taken her medications for 3 days. Her weight, on admission to ED, was 9kg above her ideal body weight.

The on-call nephrologist orders emergency hemodialysis for Cheryl whilst the ED nurses provide respiratory support with oxygen via a non-rebreather mask, at 15L per minute. Cheryl is transferred to the Renal Ward immediately post the emergency hemodialysis treatment.

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On arrival to the ward, Cheryl needs assistance to transfer from the wheelchair to the bed, where she immediately asks you lift the back of the bed up so that she can sit upright in bed. You notice that she has peri-orbital odema and the oxygen mask has left indentations on her cheeks. She also appears to be working hard to breathe and is speaking in short sentences only. Despite this, Cheryl says that she would like a cup of tea.