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Septic shock from pyelonephritis — RCPSC EM MCQ

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HardInfectious disease emergenciesSeptic shock from pyelonephritisRCPSC EM

CTAS 1. A 70-year-old has fever, flank pain, confusion, and rigors. BP remains 78/42 after 30 mL/kg balanced crystalloid, lactate is 5.8, creatinine 240, and urinalysis shows pyuria. Blood cultures are drawn and ceftriaxone is given. What is the most appropriate next step?

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Correct answer: A — Start norepinephrine and arrange ICU-level care

Septic shock with persistent hypotension after initial fluids requires vasopressor support, source assessment, and ICU-level monitoring.

Reference: Surviving Sepsis Campaign; AMMI Canada antimicrobial resources