A 74-year-old man with severe chronic obstructive - resi_hopeful

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A 74-year-old man with severe chronic obstructive pulmonary disease, type 2 diabetes mellitus, and chronic kidney disease presents to the emergency department (ED) 36 hours after developing sudden-onset right upper quadrant abdominal pain, radiating to the back, after eating his favorite meal of fried chicken. Since then the pain has persisted and has been accompanied by vomiting, fever to 38.9°C (102°F), and mild yellowing of his eyes. His family calls 911 after noticing that he is confused. On arrival at the ED his temperature is 39.4°C (103°F), pulse is 115/min, blood pressure is 88/40 mm Hg, respiratory rate is 32/min, and oxygen saturation is 96% on room air. ECG reveals sinus tachycardia with no diagnostic abnormality. Physical examination is notable for a remarkably ill-appearing man in acute distress with diffuse abdominal tenderness that localizes to the epigastrium and right upper quadrant. Despite multiple fluid boluses, the patient remains hypotensive, and norepinephrine is started while laboratory tests are still pending because of technical issues. The patient is referred for emergent endoscopic retrograde cholangiopancreatography (ERCP) on the basis of imaging consistent with gallstone pancreatitis. The patient has bleeding from all of his venous access sites when laboratory tests finally return and show profound leukocytosis, anemia, and thrombocytopenia. Coagulation studies and a peripheral smear sent stat are still pending but a fibrinogen level returns at 87 mg/dL. Liver function studies are remarkable for transaminitis and elevated indirect and direct bilirubinemia.
In addition to receiving broad-spectrum antibiotics and continuing aggressive volume resuscitation, the patient should receive what additional therapy?

A.Cryoprecipitate
B.Cryosupernatant
C.Fresh frozen plasma
D.Plasma exchange
E.Platelet transfusion
F.Platelet-poor plasma
G.RBC transfusion
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