66-year-old male presented with worsening shortness of breath over the last week. Further review of systems revealed the patient had associated nausea, vomiting, and diarrhea during this time. Of note, the patient had been recently admitted to the hospital for an exacerbation of congestive heart failure. On arrival, he was found to be febrile at 38.5C, tachycardic in 140s with irregularly irregular rhythm, hypotensive with MAP in 50s, respiratory rate at 24, and hypoxic on RA to 84%.
