Critical Care — MCQs

Question 161: A 30-year-old male is admitted with septic shock secondary to a ruptured appendix. What is the first line of treatment?

• A. Fluid resuscitation (Correct Answer)
• B. Vasopressors
• C. Broad-spectrum antibiotics
• D. Abscess drainage

Explanation: Detailed management of septic shock involves several key phases starting with stabilization. ***Fluid resuscitation*** - This is the **initial and most critical step** in managing septic shock to restore adequate **tissue perfusion** and counter hypovolemia caused by widespread vasodilation and capillary leak. [1] - Prompt administration of **intravenous fluids** helps improve blood pressure and organ function by increasing intravascular volume. *Broad-spectrum antibiotics* - While essential for treating the underlying infection, antibiotics are typically administered **after fluid resuscitation** has begun to stabilize the patient hemodynamically. [1] - Their primary role is to target the causative microorganisms, but they do not immediately address the acute circulatory collapse of shock. *Abscess drainage* - This is a crucial intervention to control the source of infection, especially in cases like a ruptured appendix where there is a contained collection of pus. [1] - However, source control through drainage is typically performed **after initial stabilization** with fluids and antibiotics. *Vasopressors* - These medications (e.g., norepinephrine) are used to increase blood pressure when **fluid resuscitation alone is insufficient** to achieve adequate mean arterial pressure. - Vasopressors are considered a second-line therapy for hemodynamic support, always following initial fluid administration.