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Septic shock from urinary source — SCE Acute Medicine MCQ

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ModerateSepsis and Infectious EmergenciesSeptic shock from urinary sourceSCE Acute Medicine

A 71-year-old woman presents with fever, systemic upset and acute deterioration. Relevant history includes a plausible infectious exposure or immunocompromising context. On assessment, NEWS2 is elevated and there are features of organ dysfunction. Investigations show hypotension, lactate 5.8, AKI and nitrite-positive urine. What is the most important immediate action?

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Correct answer: D — Give broad-spectrum intravenous antibiotics within one hour and continue sepsis resuscitation

The key discriminator is that hypotension, lactate 5.8, AKI and nitrite-positive urine, which makes Give broad-spectrum intravenous antibiotics within one hour and continue sepsis resuscitation the single best answer. Reverse anticoagulation where appropriate is less appropriate because it does not address the dominant acute risk in the vignette; Give hypertonic saline bolus would fit a different presentation or later stage of care. Give broad-spectrum intravenous antibiotics within one hour and Give intramuscular adrenaline immediately are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: NICE NG253