A 67-year-old woman with a history of dyslipidemia, who comes to the ED with dysuria and pollakiuria followed by fever, chills, and deterioration of general condition. On arrival she appears severe and is tachycardic, tachypneic, with blood pressure 60/40 mmHg and temperature of 39°C. Which of the following measures would NOT be included in the INITIAL management?
Patient presenting with fever+tachypnea+FC>100 = 3 criteria of SIRS (Systemic Inflammatory Response Syndrome). Reminder: sepsis is a SIRS due to infection, which leads to a decrease in SVR, resulting in a decrease in preload and stroke volume leading to hypotension. The first therapeutic measures are the administration of empirical broad-spectrum antibiotics and fluid replacement (answer 4) to try to compensate for this decrease in preload. Of choice, balanced crystalloids and albumin solutions [1] But when this is insufficient, we must try to correct the decrease in PVR by using vasoactive drugs [2]. But the vasoactive drug of choice in the context of septic shock is noradrenaline ([3], [4]) (answer 1 FALSE) A minimum of two blood cultures is mandatory (answer 3), for the diagnosis of bacteremia and facilitating a targeted antibiotic treatment. [2] On the other hand, it is interesting to determine blood lactic acid levels for two purposes: it is currently considered the best marker of tissue hypoperfusion/hypoxia and it predicts the response to treatment[2] (answer 2).
Intravenous perfusion of dobutamine.
Serum lactate measurement.
Extraction of blood cultures.
Fluid administration.
the vasoactive drug of choice in the context of septic shock is noradrenaline ([3], [4]) (answer 1 FALSE)
On the other hand, it is interesting to determine blood lactic acid levels for two purposes: it is currently considered the best marker of tissue hypoperfusion/hypoxia and it predicts the response to treatment[2] (answer 2).
A minimum of two blood cultures is mandatory (answer 3), for the diagnosis of bacteremia and facilitating a targeted antibiotic treatment.
sepsis is a SIRS due to infection, which leads to a decrease in SVR, resulting in a decrease in preload and stroke volume leading to hypotension. The first therapeutic measures are the administration of empirical broad-spectrum antibiotics and fluid replacement (answer 4) to try to compensate for this decrease in preload.