A 68-Year-Old Man with Bilateral Percutaneous Nephrostomy Tubes Is Brought

A 68-year-old man with bilateral percutaneous nephrostomy tubes is brought to the emergency department by his wife because of altered mental status. The wife says that he is "not his usual self" and responded with nonsensical phrases when she awoke him for breakfast. He appears uncomfortable and diaphoretic. He is oriented to person but not to place or time. His temperature is 36.8°C (98.2°F) , pulse is 124/min, respirations are 22/min, and blood pressure is 76/50 mm Hg when supine. Pulse oximetry on room air shows an oxygen saturation of 96%. In the emergency department, a central venous catheter is placed and hemodynamic monitoring shows: Which of the following is the most likely cause of this patient's hypotension?

A) Bacterial infection
B) Gastrointestinal bleeding
C) Heart failure
D) Hypothermia
E) Myocardial infarction
F) Pulmonary embolism

Correct Answer:

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