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Septic shock — MCCQE Part 1 MCQ

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EasySepsisSeptic shockMCCQE Part 1

68-year-old woman presents with fever, confusion and hypotension. Lactate is 4.2 mmol/L and pneumonia is suspected. Which of the following is the most appropriate next step?

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Correct answer: A — Give oxygen, cultures, broad-spectrum antibiotics and crystalloid resuscitation promptly

Give oxygen, cultures, broad-spectrum antibiotics and crystalloid resuscitation promptly is best because hypotension, infection and elevated lactate indicate septic shock. Wait for confirmatory testing before any stabilisation is suboptimal because resuscitation and time-critical treatment should not wait when instability is present; Discharge once symptoms temporarily improve is suboptimal because temporary improvement can precede deterioration; Give an adjunctive medication as the sole first-line treatment is suboptimal because adjuncts do not replace definitive stabilisation; Delay escalation until cardiac arrest or respiratory failure occurs is suboptimal because early escalation is central to emergency care. Antibiotics and fluids should be early but reassessed.

Reference: Surviving Sepsis Campaign; Canadian critical care practice