ICU Knowledge Map

R1Recognition & First Steps

Initial Presentation

Septic Shock Resuscitation

A 68-year-old man with COPD presents with 3 days of productive cough, fever, and progressive confusion. Pneumonia is suspected and blood cultures/antimicrobials are being addressed urgently.

Vital Signs

118/min

82/45 mmHg (MAP approximately 57 mmHg)

28/min

SpO2

90% on 4 L/min nasal oxygen

Temp

39.2°C

Key Bedside Findings

Warm extremities and bounding pulses are compatible with distributive vasoplegia but do not exclude intravascular volume depletion.
Serum lactate 4.2 mmol/L.
Bedside echo shows a hyperdynamic LV. IVC respiratory variation may contribute to the assessment but should not be used alone to diagnose fluid responsiveness.

How this R1 case develops

Recognition → stabilization → basic reassessment

1. Recognition2. Immediate stabilization3. Basic reassessment

One dominant problem, clearer signals, immediate teaching feedback.

Learning targets

• Begin sepsis resuscitation immediately with balanced crystalloid and early vasopressor support when unstable shock is present.
• Use norepinephrine as first-line vasopressor and add vasopressin when norepinephrine requirements are escalating.
• Guide additional fluid after initial resuscitation with dynamic measures rather than static IVC/CVP findings alone.
• Interpret lactate together with capillary refill, urine output, mental status, and other perfusion markers rather than treating lactate as a pure marker of anaerobic metabolism.