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Fluid-refractory septic shock — RACP Paediatrics MCQ

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HardEmergencyFluid-refractory septic shockRACP Paediatrics

A 3-year-old with septic shock has received antibiotics and four carefully reassessed 10 mL/kg crystalloid boluses. Hypotension, altered consciousness and poor perfusion persist, and no further fluid-responsive signs are present. Central access is not yet available. What is the next priority?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Start peripheral IV/IO vasoactive support with urgent PICU consultation

Explanation lettering: E = shown as C · C = shown as D · D = shown as E

C is correct. RCH identifies persistent shock after 40 mL/kg fluid as a PICU-transfer trigger and emphasises early inotropes or vasopressors, which may start through peripheral IV or IO access during resuscitation. D risks fluid overload and ignores the loss of fluid responsiveness. E imposes a harmful delay; central access is not required for initial vasoactive support. A may be considered in catecholamine-resistant shock or adrenal insufficiency but is not sole first escalation. B delays treatment of clinically evident shock for a laboratory value. The specific vasoactive agent is selected according to haemodynamic phenotype and local intensive-care guidance while frequent reassessment and source control continue.

Reference: Royal Children’s Hospital Melbourne: Sepsis—assessment and management: https://www.rch.org.au/clinicalguide/guideline_index/SEPSIS_assessment_and_management/