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Urosepsis with septic shock physiology — SCE Acute Medicine MCQ

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EasyInfectious diseasesUrosepsis with septic shock physiologySCE Acute Medicine

An 82-year-old woman from a care home is admitted with fever, confusion and reduced oral intake. Observations show temperature 38.7°C, RR 26/min, pulse 118/min, BP 94/56 mmHg and new oxygen requirement of 3 L/min. Urine dipstick is positive for nitrites and leucocytes; lactate is 3.4 mmol/L. NEWS2 is high. What is the most appropriate next step in management?

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Correct answer: A — Give broad-spectrum intravenous antibiotics within 1 hour after blood cultures and start fluid resuscitation

This patient has suspected sepsis with high-risk features, hypotension and raised lactate. NICE recommends prompt IV broad-spectrum antibiotics for high-risk suspected sepsis after appropriate cultures, alongside resuscitation and escalation. Deferring antibiotics for imaging or culture confirmation risks deterioration, while sedating delirium before treating sepsis misses the reversible cause.

Reference: NICE NG253