Reference no: EM133687975

Question

An 85-year-old patient is admitted to the hospital with septic shock secondary to E. coli bacteremia from a urinary infection. She is started on broad spectrum antibiotics, fluid resuscitated, and placed on high-flow nasal cannula. Despite appropriate treatment, four days into her hospitalization, her oxygen saturation continues to trend down, and she remains obtunded. Her daughter is her medical Durable Power of Attorney (DPOA). Her daughter notes that her mom has had increasing weakness when at home. The patient lived on her own and had always maintained that she would not want to be institutionalized. The ICU attending is called to evaluate the patient as there is concern she may need to be intubated given increased work of breathing. Given the patient's frailty, the intensivist is worried the patient may need prolonged mechanical ventilation or be unable to wean off the ventilator. Medical history is significant for mild cognitive impairment, hypertension, and congestive heart failure. Medications are aspirin, lisinopril, carvedilol, and furosemide. Physical examination shows a frail, older woman in moderate respiratory distress. She does not respond to verbal or tactile stimuli; moans occasionally but is not able to engage with the examiner. Tachycardic with 3/6 systolic murmur. Bibasilar crackles.