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Adult septic shock from pneumonia — RCPSC EM MCQ

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HardInfectious disease emergenciesAdult septic shock from pneumoniaRCPSC EM

CTAS 1: A 67-year-old with COPD presents with fever, productive cough and confusion. Vitals are BP 78/46 after 1.5 L crystalloid, HR 124, RR 32, SpO2 90% on 6 L. CXR shows right lower-lobe consolidation; lactate is 5.6 mmol/L and creatinine is rising. What is the most appropriate initial management?

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Correct answer: C — Start norepinephrine and broad-spectrum antibiotics with source-directed resuscitation

Persistent hypotension after fluids with infection and high lactate is septic shock. Norepinephrine is first-line vasopressor, alongside early antibiotics, cultures when feasible and source evaluation.

Reference: CAEP vasopressor consensus; BC Sepsis ED Guidelines; Surviving Sepsis Campaign