On arrival to the ICU his heart rate was 108bpm, blood pressure was 128/85, respiratory rate was 22/minute and O2 sat was 99% on room air.

The initial labs in the ICU are shown here:

The patient went on to develop multiple episodes of bloody vomiting. He was given normal saline and a transfusion of RBCs. His blood pressure continued to decline and the vomiting became more copious.

Anesthesia was consulted for intubation due to concern that he could not protect his airway. Their consultation note and procedure note are shown here.

The patient’s hemodynamic status continued to decline. The remainder of his hospital care is described below.

The autopsy is shown on the next page.