A 66-year-old man with severe left heart failure is receiving an inotropic medication. He presents with altered mental status, increased breathing difficulty, and hypotension. What should you do?

In this scenario, the patient is experiencing severe symptoms related to heart failure, including altered mental status, increased difficulty in breathing, and hypotension. While it may initially seem logical to discontinue the inotropic medication due to the hypotension, the key to this situation lies in understanding the complex dynamics of heart failure and the need for careful management of the patient’s condition.

Supporting the patient's breathing is critical because respiratory distress could rapidly lead to further complications. Continuing the infusion, despite the hypotension, suggests that the patient may require ongoing support from the medication to improve cardiac output and manage heart failure. Inotropic medications are specifically used in these situations to increase contractility and improve blood flow, which may help stabilize the patient. However, monitoring is crucial, and any further adjustments to the medication or patient condition should be guided by medical control.

Contacting medical control is important because they can provide advanced guidance and potentially adjust the patient’s management plan, ensuring that the patient receives the appropriate level of care based on the current presentation.

Thus, maintaining support for the patient's respiratory needs while continuing to supply inotropic support under guidance addresses both the symptoms of heart failure and the potential for better management of hypotension in a critical situation.