A 65-year-old woman with severe sepsis receives initial fluids and antibiotics. Lactate decreases from 5.5 to 2.8 mmol/L but MAP remains 60 mmHg. Afte...

Question

A 65-year-old woman with severe sepsis receives initial fluids and antibiotics. Lactate decreases from 5.5 to 2.8 mmol/L but MAP remains 60 mmHg. After starting norepinephrine, she remains hypotensive. Next adjunct?

Accepted Answer

Add vasopressin to norepinephrine

Answer

Switch to dopamine

Answer

Use phenylephrine alone

Answer

Immediate hydrocortisone for all

Answer

Large additional fluid boluses without reassessment

Refractory Septic Shock — MRCEM SBA MCQ

A 65-year-old woman with severe sepsis receives initial fluids and antibiotics. Lactate decreases from 5.5 to 2.8 mmol/L but MAP remains 60 mmHg. After starting norepinephrine, she remains hypotensive. Next adjunct?