Case of the Week: January 22, 2020

This is a 74yo F with a past medical history significant for ESRD and severe PVD who was transferred to the ICU overnight with presumed septic shock thought to be related to left foot osteomyelitis. She had presented to the ED with refractory hypotension and altered LOC necessitating intubation and high dose vasopressors. The POCUS team went to do a focused cardiac exam, primarily to see if there was a cardiogenic component to his shock. The following TTE images were taken and the decision was made to perform a point-of-care TEE. What do you think is going on?