21 y.o. female with history of IVDA presents with fever and confusion. She is toxic in appearance. Her vitals reveal: BP 96/70, HR 136, RR 24 and T 39.1. She appears dehydrated and family supports that she has been lying in bed in her apartment without any food or water for at least 2 days. She is uncooperative with history and physical examination due to her confusion. No murmur can be heard but you note the following physical findings... 
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