A 65-year old man presents to you ED in septic shock. His urine is foul smelling and his wife mentions he had several days of dysuria and his blood pressure was extremely high at his last doctor’s appointment this week. His comorbidities include HTN, hyperlipidemia and diabetes. He is currently taking metformin, but hasn’t taken his other medications in months. You have given him broad-spectrum antibiotics, 3L of RL, and his MAP is now 65. He is drowsy, and confused, and his HR is 140. What is your best next step?

About the Author: Anton Helman

Dr. Anton Helman is an Emergency Physician at North York General in Toronto. He is an Assistant Professor at the University of Toronto, Division of Emergency Medicine and the Education Innovation Lead at the Schwartz-Reisman Emergency Medicine Instititute. He is the founder, editor-in-chief and host of Emergency Medicine Cases.