A 74 year old woman with a history of HTN, DM, CAD, and righ…

A 74 year old woman with a history of HTN, DM, CAD, and right sided heart failure presents to your unit with urosepsis and septic shock. Her vital signs are the following: T 104.2F, HR 123, BP 77/48 (MAP 58), RR 31, O2 saturation 92% on 5L NC. On exam, she reports feeling short of breath, and has +3 pitting edema. Which of the following most likely indicates the patient is intravascularly dry?

A 58 year old with a history of hypertension, diabetes, end…

A 58 year old with a history of hypertension, diabetes, end stage renal disease, and peripheral vascular disease presents after a car accident with a left pneumothorax, and in hypovolemic shock from multiple hemorrhaging sites. The patient is given 2L of lactated ringers to improve the blood pressure, until ordered blood products arrive. The patient’s blood pressure improves after the first liter, but does not respond to the second, so a Norepinephrine (Levophed) gtt is ordered. Given the information provided, which of the following accesses placed emergently would be most appropriate for a vasopressor infusion?