A 64-year-old white female with a PMH of metastatic breast CA, hypertension, osteoarthritis and peripheral vascular disease presents to the ED after being noted by family to have mental status changes. She is currently undergoing her third round of chemotherapy and her last treatment was 3 days ago. Her daily meds include: fentanyl patch, percocet, tenormin, and naprosyn. Family has noted that the patient has been vomiting and complaining of being weak.
You are asked to see the patient by one of your nurses because "she looks like she is going to die." On exam, you note that she has a blood pressure 
of 68/40, heart rate of 78, respiratory rate of 36 and a temperature of 35.5 rectally.
Your mind is flooded with potential diagnoses: pulmonary emboli, GI bleed or internal hemorrhage, pericardial tamponade, adverse medication effect, sepsis and MI. Physical exam, EKG, CXR and stat lab testing reveal no evidence of an acute STEMI, pneumonia, gi bleeding or obvious focus for infection. She was found to have a severe neutropenia as well has hypercalcemia. There is no change in her exam with the administration of narcan.
You quickly grab your ultrasound machine and note the following: