From what you are describing this order is what I would expect for a patient in severe sepsis. For a ventilated pt you bolus 500ml fluid for the first 12 hrs for a CVP <12. Levophed is usually the drug of choice for BP support then adding vasopressin if BP remains inadquate after 4 hrs of being on levo.
The physio in a nutshell: In severe sepsis inflammatory mediators are released into the blood stream. Vessels are damaged and as a result the capillaries become leaky, hence the edema in presence of profound low bp and intavascular dehydration. Multiple organ systems are affected, usually first a tachycardia followed by sl drop in BP (slight d/t compensation), markedly decreased renal function/failure, then a decrease in LOC. The damage to the vessel walls from the inflammatory mediators stimulates production of platelets to the affected areas causing widespread clotting of microvasculature. By that time severe sepsis has progressed to severe septic shock syndrome, end organ perfusion is severely compromised, multiple organ systems have or begin to fail which is now clinically detectable and pts mortality rates skyrocket. Respiratory failure ensues followed by cardiovascular collapse if not treated. Your pt has ascites which may indicate liver damage d/t hypoperfusion, which will be further exacerbated by abdominal compartment syndrome. The goal of sepsis is early detection, massive fluid replacement for the first 12-24 hrs, and BP support with levophed, vasopressin, and dobutamine if scvo2 is WDL. Also blood products are used when hct is less than 30, scvo2 down, and bp/cvp remains low. I've seen coutless pts not receive adequate fluids because of the 'fear of CHF, presnece of edema and so on
. If CHF and resp distress is a concern intubate. Hope this helped.