Marvin

Marvin is a 67 year old male with a long history of tobacco and substance abuse, including recent crack cocaine. This morning a visiting home health nurse found him confused and disoriented and in moderate respiratory distress, with a productive cough. His blood pressure was 185/120, with a respiratory rate of 36 and a temperature of 102 F. His O2 Saturation was 87%. He was transported to the Emergency Department by ambulance and was intubated on arrival due to worsening respiratory distress. He was transferred to the medical ICU with a diagnosis of pneumonia, and possible sepsis.

His past medical history includes poorly controlled hypertension, chronic renal insufficiency, and polysubstance abuse. He has not improved over night, and he has stopped making urine. He is now on low, but increasing doses of norepinephrine and vasopressin infusions. His blood cultures returned positive this morning for MRSA.