A case of mistaken identity

The case It is five o'clock in the morning, and you and your on-call team have been up all night pushing blood, scopolamine, and fluid (not necessarily in that order) into the parade of trauma patients and emergent cases that have come to your operating rooms (ORs). You have five people on your team (four residents and one attending), and two are in rooms already. A call comes out from the wilderness of the surgical intensive care unit (ICU) – a critically ill renal transplant patient with an open abdomen needs to come back to the OR emergently because he may be bleeding. You and the free members of your team hastily dispatch to the ICU to find the patient sedated, vented, and on pressors, with a pulmonary artery catheter in place that has been demonstrating worrisome values for the last few hours. Many other patients in the unit are equally unhealthy, and the staff is in a surly and foul mood from a mixture of high patient acuity, a sick call-out, too much instant coffee, and some questionable salty snack foods. You and your team slunk through the unit seeking the fellow who provides a thumbnail sketch of the last eight-hour course and the general history of the patient. None of it sounds good. You attach your transport monitors – make sure you have your emergency drugs and airway equipment and undock from the mother ship, taking care not to rip any lines out of the patient or wires or tubing out of the wall.