Sepsis Quiz: Ace Your Exams

An 84-year-old man presents to the emergency department from a nursing facility after a fall. Paramedics report that the nursing home staff reported that the patient has been more fatigued over the past 24 hours. The patient cannot provide a history due to baseline mental status from Alzheimer dementia which the nursing home staff reported as unchanged. The patient has a history of hypertension, diabetes mellitus, Alzheimer dementia, and coronary artery disease. Temperature is 39.0°C (102.2°F), blood pressure is 82/65 mmHg, pulse is 114/min, respiratory rate is 24/min, and oxygen saturation is 95% on room air. On physical exam the patient is fatigued and ill-appearing. The patient is provided with intravenous fluids, piperacillin-tazobactam, and vancomycin; and bloodwork (including blood cultures) is obtained. Results of the initial work-up are detailed below. A central venous catheter is placed and norepinephrine is started. Which of the following is the best next step in management?
 
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