A 45-year-old female presents to the emergency department in septic shock with a mean arterial pressure (MAP) of 52 mmHg despite receiving 30 mL/kg of IV crystalloids. Which vasopressor is the first-line agent of choice per the Surviving Sepsis Campaign guidelines?
Answer and explanation
Correct answer: C. Norepinephrine
- Step 1: Septic shock requires vasopressor support when fluid resuscitation fails to restore an adequate perfusion pressure (target MAP ≥ 65 mmHg).
- Step 2: Surviving Sepsis Campaign guidelines recommend Norepinephrine as the first-line vasopressor because its potent α₁-vasoconstrictor and modest β₁-inotropic effects restore vascular tone with lower tachyarrhythmia rates than dopamine.
Answer
Norepinephrine.
Why not the others: Dopamine is associated with higher tachyarrhythmia rates and mortality; Phenylephrine lacks inotropic support; Epinephrine is a second-line add-on agent.
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