Shock

A 74 year old man is admitted with hypotension. On admission his ECG demonstrated inverted T waves across his anterior leads, with positive cardiac enzymes. He is admitted to coronary care. He remains hypotensive. A nurse notices a black patch on his right buttock, and calls the intern. Unsure as to the diagnosis, the intern correctly consults the surgeons on call, who make a diagnosis of necrotizing fasciitis and rush the patient to the operating room, where a large debridement takes place. He is returned to you in the surgical intensive care. On admission, he is ventilated, blood pressure is 90/50, heart rate 120, CVP 12, minimal urinary output, on dopamine 3mic/kg/minute.

What do you think?

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