It's 4am and you're recieving a 60y/o female for a exploratory laparotomy. Hospitalised for a couple of days with abdominal pain, and now septic and a decreased loc. Bp: 80/50, spo2: 85 with 15l nrb, heartrate:130, resp: 25, urine output: 0

ICU already placed 2 large bore IV's, arterial line and a central line. Fluids include albumin, 2 hespan and 2 litres of cristalloids. Inotropes include norepinephrine and dobutamine

The patient was intubated prior to bringing her to you because of the vital signs. Sedated with midazolam and sufentanil gtt.

Vital signs are still deteriorating as you transfer the patient onto the gurney: bp: 70/35, hr: 100 and dropping, spo2: 50

What's happening? what needs to be done right now? Surgeon asks if he can please start now!