A 68-year-old female presents to the emergency department with confusion, fever, and rapid breathing. Her vital signs are: BP 85/50 mmHg, HR 120 bpm, RR 28/min, Temp 39.5°C (103.1°F), and SpO2 94% on room air. Which of the following is the most appropriate initial intervention?
Obtain blood cultures
Administer IV fluids
Start vasopressors
Initiate oxygen therapy
The correct answer is to administer IV fluids. In sepsis, early aggressive fluid resuscitation is crucial to improve tissue perfusion and organ function. The Surviving Sepsis Campaign guidelines recommend rapid administration of 30 mL/kg of crystalloid fluid within the first 3 hours for patients with sepsis-induced hypoperfusion. This patient shows signs of sepsis (confusion, fever, tachypnea) and hypotension, indicating the need for immediate fluid resuscitation.
While oxygen therapy and obtaining blood cultures are also important in managing sepsis, fluid resuscitation takes priority due to the patient's hypotension. Administering vasopressors is typically considered after initial fluid resuscitation if the patient remains hypotensive, making it premature as an initial intervention in this scenario.
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