A 68-year-old woman is brought to the emergency department due to worsening fever, cough, and confusion. The patient has had a "cold and congestion" since last week, which initially improved, but she began feeling worse again 3 days ago. Her daughter reports that the patient has also been eating poorly. Other medical conditions include chronic obstructive pulmonary disease and chronic kidney disease. Temperature is 39.4 C (102.9 F), blood pressure is 74/46 mm Hg, pulse is 128/min, and respirations are 30/min. Oxygen saturation is 94% on 2 L/min. On physical examination, the patient is lethargic with dry mucous membranes and flat neck veins. Lung examination reveals dullness to percussion and crackles at the right base. Chest x-ray shows a right lower lobe consolidation. Intravenous access is established. Intravenous administration of which of the following is the most appropriate next step in management of this patient?

Question

A 68-year-old woman is brought to the emergency department due to worsening fever, cough, and confusion.  The patient has had a "cold and congestion" since last week, which initially improved, but she began feeling worse again 3 days ago.  Her daughter reports that the patient has also been eating poorly.  Other medical conditions include chronic obstructive pulmonary disease and chronic kidney disease.  Temperature is 39.4 C (102.9 F), blood pressure is 74/46 mm Hg, pulse is 128/min, and respirations are 30/min.  Oxygen saturation is 94% on 2 L/min.  On physical examination, the patient is lethargic with dry mucous membranes and flat neck veins.  Lung examination reveals dullness to percussion and crackles at the right base.  Chest x-ray shows a right lower lobe consolidation.  Intravenous access is established.  Intravenous administration of which of the following is the most appropriate next step in management of this patient?

Quizplus · Accepted Answer

Eductional Objective: The initial management of septic shock requires rapid fluid resuscitation to replace intravascular volume and restore adequate end-organ perfusion.  This is best accomplished with intravenous boluses of isotonic crystalloid in the form of 0.9% (normal) saline or lactated Ringer solution because these solutions remain in the extracellular space.

A 68-Year-Old Woman Is Brought to the Emergency Department Due