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Septic shock vasopressor initiation — RCPSC EM MCQ

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HardResuscitation, procedures, airwaySeptic shock vasopressor initiationRCPSC EM

A 68-year-old man in septic shock from pneumonia has received 30 mL/kg crystalloid and antibiotics. Blood pressure remains 76/42 mmHg, lactate is 5.1 mmol/L, lungs have new crackles, and ultrasound shows a plethoric IVC with poor LV function. What is the most appropriate next step?

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Correct answer: D — Start norepinephrine and arrange ICU admission

Persistent hypotension after initial fluid resuscitation with signs of poor fluid tolerance should prompt vasopressor support, usually norepinephrine, and ICU-level care rather than indiscriminate fluids.

Reference: Surviving Sepsis Campaign; Canadian critical care practice