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Septic shock requiring vasopressor support — SCE Acute Medicine MCQ

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ModerateCritical care medicineSeptic shock requiring vasopressor supportSCE Acute Medicine

A 63-year-old woman with biliary sepsis remains hypotensive after 30 mL/kg balanced crystalloid and antibiotics. Blood pressure is 78/42 mmHg, lactate is 5.9 mmol/L and urine output is minimal. Bedside ultrasound shows a plethoric IVC and poor cardiac contractility is not evident. What is the most appropriate next step in management?

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Correct answer: B — Start norepinephrine while critical-care support is arranged

Persistent hypotension and hypoperfusion after adequate fluid assessment represent septic shock. Norepinephrine is the preferred first vasopressor and can begin peripherally through a suitable closely observed cannula while central access is organised. Further indiscriminate fluid can worsen oedema; dobutamine is reserved for relevant cardiac dysfunction.

Reference: https://www.nice.org.uk/guidance/NG253/chapter/managing-suspected-sepsis