Scenario

Mo Rashid is an 56-year-old man who has presented to the Emergency Department with his wife. He has had fever and feeling progressively more unwell for 3 days. He has been diagnosed with prostate cancer and started chemotherapy three weeks ago. He wife reports he has had pain and difficulty passing urine for a week.

On arrival to the Emergency Department, Mo appears drowsy but responds when you speak with him. He is flushed and slightly sweaty. Despite having registed on arrival he is unaware of where he is or why he is there.

Observations:

RR 25/min
SpO2 89% on room air
HR 121/min
BP 87/56 mmHg
CRT 5 seconds
Temp. 40.3°C
CBG 9.8mmol/L
Urine output Has has not passed any urine for the last 12 hours

Mo has been diagnosed with septic shock secondary to a urinary tract infection.

The medical team have prescribed intravenous fluid challenges, but Mo is refusing to have a cannula inserted.

Question:
Using the information in the scenario and a structured ABCDE approach, discuss the assessment and management of Mo’s deteriorating condition. Your essay should include a discussion of Mo’s mental capacity.

Word count: 2000 (maximum)