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Septic shock requiring vasopressors — RCPSC EM MCQ

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HardInfectious disease emergenciesSeptic shock requiring vasopressorsRCPSC EM

A 70-year-old man presents CTAS 1 with pneumonia, confusion and hypotension. BP is 78/44 after 30 mL/kg balanced crystalloid, lactate is 5.4 mmol/L, and broad antibiotics have been given. Bedside ultrasound shows a non-collapsible IVC and poor LV function. What is the most appropriate initial management?

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Correct answer: C — Start norepinephrine and reassess perfusion while arranging ICU care

Septic shock persisting after initial fluids requires early norepinephrine, including via well-sited peripheral access while central access is arranged, plus reassessment of fluid responsiveness.

Reference: CAEP sepsis guidance; Emergency Care BC sepsis guideline