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Septic shock after source control — FRCA Final MCQ

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ModerateICUSeptic shock after source controlFRCA Final

A 68-year-old woman with perforated diverticulitis is admitted to ICU after laparotomy. After 30 ml/kg crystalloid she remains hypotensive with lactate 5.8 mmol/L, warm peripheries, temperature 39°C and urine output 10 ml/hour. Blood cultures have been taken and broad-spectrum antibiotics started. What is the most appropriate management?

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Correct answer: E — Start noradrenaline infusion and assess fluid responsiveness

Persistent septic shock after initial fluid resuscitation requires vasopressor support, with noradrenaline as the usual first-line agent, while reassessing fluid responsiveness. Repeated unselected fluid boluses risk oedema and organ dysfunction. Dopamine has more arrhythmic effects and is not preferred. Lactate reflects shock and stress; bicarbonate is not definitive therapy for tissue hypoperfusion.

Reference: Surviving Sepsis Campaign 2021; NICE sepsis guidance NG253/NG254/NG255