A 65-year-old man arrives as ESI 2 with fever, dysuria, flank pain, and confusion. BP 82/48 after 1 L crystalloid, HR 126, lactate 5.0 mmol/L, WBC

Question

A 65-year-old man arrives as ESI 2 with fever, dysuria, flank pain, and confusion. BP 82/48 after 1 L crystalloid, HR 126, lactate 5.0 mmol/L, WBC 22,000/mcL, and urinalysis shows pyuria. Which of the following is the most appropriate next step in management?

Accepted Answer

Begin norepinephrine and broad-spectrum IV antibiotics

Answer

Discharge with oral fluoroquinolone therapy

Answer

Administer oral acetaminophen and repeat vitals

Answer

Delay antibiotics until CT confirms pyelonephritis

Answer

Give nitrofurantoin and observe for 2 hours

Septic shock from pyelonephritis — ABEM Board MCQ

A 65-year-old man arrives as ESI 2 with fever, dysuria, flank pain, and confusion. BP 82/48 after 1 L crystalloid, HR 126, lactate 5.0 mmol/L, WBC 22,000/mcL, and urinalysis shows pyuria. Which of the following is the most appropriate next step in management?