In septic shock, which is a key initial therapy?

In septic shock, which is a key initial therapy?

• A. Invasive ventilation
• B. Anticoagulation
• C. Rapid IV crystalloids
• D. Immediate surgery

Answer: (C)

In septic shock, the most important first step is to rapidly restore intravascular volume with isotonic intravenous fluids. Sepsis triggers widespread vasodilation and increased capillary permeability, which leads to a drop in the effective circulating blood volume and impaired tissue perfusion. Administering fluids quickly increases preload, improves stroke volume and cardiac output, and helps push mean arterial pressure back toward a perfusion level. This foundational stabilization is what buys time for antibiotics to kill the infection and for source control to be addressed. A common target is about 30 mL/kg of crystalloids within the first 3 hours, guided by blood pressure, urine output, and perfusion markers, with careful monitoring for signs of overload in patients with heart or kidney disease. Other interventions, like ventilation, anticoagulation, or immediate surgery, may be needed later or in specific scenarios, but they do not address the immediate hemodynamic instability as effectively as rapid fluid resuscitation.

In septic shock, the most important first step is to rapidly restore intravascular volume with isotonic intravenous fluids. Sepsis triggers widespread vasodilation and increased capillary permeability, which leads to a drop in the effective circulating blood volume and impaired tissue perfusion. Administering fluids quickly increases preload, improves stroke volume and cardiac output, and helps push mean arterial pressure back toward a perfusion level. This foundational stabilization is what buys time for antibiotics to kill the infection and for source control to be addressed. A common target is about 30 mL/kg of crystalloids within the first 3 hours, guided by blood pressure, urine output, and perfusion markers, with careful monitoring for signs of overload in patients with heart or kidney disease. Other interventions, like ventilation, anticoagulation, or immediate surgery, may be needed later or in specific scenarios, but they do not address the immediate hemodynamic instability as effectively as rapid fluid resuscitation.