Septic shock kills by the hour, and the Hour-1 bundle is a nursing bundle — lactate, cultures, antibiotics, 30 mL/kg of crystalloid and vasopressors all begin at your bedside. Work the clock: every action costs minutes, and some cost you the hour. Then switch to the distributive bench and choose the first drug for three patients whose vasodilatation has three different causes.
Mr Cole, 68, 70 kg. Post-op day two, sigmoid colectomy.
Temperature 38.6°C, heart rate 124, blood pressure 84/48, respiratory rate 26, warm flushed skin with bounding pulses, urine output 15 mL/hr for three hours, and he is newly confused. You have just recognised sepsis. The clock starts now.
Minutes since recognition
0
Choose your next action. Each one takes real time.
Available actions
All three of these patients are vasodilated and hypotensive. All three have a very low systemic vascular resistance. The cause is different in each, and so is the first drug. Name the shock and choose the drug.