Review Question - QID 216763

A 55-year-old man presents to the emergency department acutely obtunded. The patient’s wife noticed that he was feeling sick for the past several days and seemed to be getting worse. Today, he was confused and somnolent. The patient has a history of diabetes and asthma. He was recently hospitalized for an asthma exacerbation. His temperature is 102.0°F (38.9°C), blood pressure is 70/35 mmHg, pulse is 142/min, respirations are 16/min, and oxygen saturation is 90% on room air. Physical exam reveals an obtunded man who is not following commands. A chest radiograph is performed as seen in Figure A. An ECG is performed as seen in Figure B. The patient is intubated and given 30 cc/kg of Ringer lactate. His subsequent vitals are 75/34 mmHg with a pulse of 140/min. The patient requires maximal doses of norepinephrine, epinephrine, and vasopressin, after which his blood pressure is noted to be 80/40 mmHg. Which of the following is the most appropriate next step in management?