QuestionSBA
QuestionChoice
Although this should also be considered, this patient's tachycardia is likely due to her septic shock rather than primary cardiac pathology. Fluid resuscitation should therefore be prioritised.
10027529
d
Perform a head-tilt chin-lift manouvre
QuestionChoice
This is the correct answer. It is important to correct the patient's severe hypotension first. This, along with her tachycardia, indicates septic shock which may be secondary to a urinary tract infection.
10027526
a
Administer 500ml bolus of 0.9% saline
QuestionChoice
This answer is incorrect. The patient's saturations are within normal limits. It is therefore more important to address her hypotension.
10027528
c
Give 15L oxygen through a non-rebreather mask
QuestionChoice
This answer is incorrect. Blood glucose can be used to guide management in sepsis however glucose is already reported on the patient's venous blood gas.
10027530
e
Measure capillary blood glucose
QuestionChoice
Although this should also be considered, this patient's tachycardia is likely due to her septic shock rather than primary cardiac pathology. Fluid resuscitation should therefore be prioritised.
10027527
b
Perform a 12 lead ECG
Concept
Chapter
2693
4035
Sepsis
Topic
161
Emergency Medicine
Administer 500ml bolus of 0.9% saline
17903
A 25-year-old female is brought to A&E by ambulance on day 2 of antibiotics for a suspected UTI. She reports feeling extremely unwell with nausea and lower back pain. She has no past medical history and no allergies to any medication.



On examination:



She is alert to voice, appears pale and has an elevated work of breathing.



Her observations are as follows:



RR - 24.
HR - 123.
BP - 81/55.
Temperature - 38.5C.
O2 saturations - 97% on air.



An venous blood gas is obtained and the results are shown below:



||||
|--------------|:-------:|------------------|
|pH|7.2|7.35 - 7.45|
|PaO₂|12.5 kPa|11 - 15|
|PaCO₂|4.6 kPa|4.6 - 6.4|
|Bicarbonate|20 mmol/L|22 - 30|
|Lactate|5 mmol/L|0.6 - 1.4|
|Non-fasting Glucose|9.7 mmol/L|< 6.1|



What is the most important initial management step?
a