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Septic shock — RCPSC IM MCQ

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HardCritical CareSeptic shockRCPSC IM

A 58-year-old with pyelonephritis remains hypotensive at 82/46 mmHg after an initial 30 mL/kg balanced-crystalloid bolus. Lactate is 5.2 mmol/L; cultures and antibiotics have been given. What is the best next hemodynamic step?

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Correct answer: D — Start norepinephrine and reassess urgently for source control

The best answer is “Start norepinephrine and reassess urgently for source control”. Persistent shock after initial fluid resuscitation warrants norepinephrine, which may begin through a suitable peripheral line while definitive access is arranged. Unstructured additional fluid risks overload, dopamine is not renal-protective, central access should not delay support and corticosteroid is not the first vasopressor step.

Reference: Emergency Care BC, emergency-department sepsis guideline: https://emergencycarebc.ca/wp-content/uploads/2022/03/2022-Emergency-Department-Guidelines-FINAL.pdf