A patient in septic shock shows systolic BP 85 mmHg, HR 110, RR 26, SpO2 92% on room air. What is the nurse's first action?

• A. Ensure airway and breathing; administer oxygen and activate the rapid response or call for help; obtain IV access.
• B. Start IV fluids and monitor BP only.
• C. Wait for blood culture results before acting.
• D. Place patient in Trendelenburg.

Answer: (D)

In septic shock, the first priority is stabilizing the patient by keeping the airway and breathing adequate while preparing for rapid intervention. The patient is tachypneic and hypoxemic on room air, so providing supplemental oxygen is essential to improve oxygen delivery to tissues. At the same time, activating the rapid-response team brings in additional help and resources, which is crucial when someone is in shock. Establishing IV access early is also important to start fluid resuscitation, antibiotics, and any needed vasopressors promptly.

Placing the patient in Trendelenburg is not appropriate in shock. This position does not reliably improve perfusion or oxygenation and can worsen breathing, increase intracranial pressure, and risk aspiration. Waiting for blood culture results before acting delays life-saving treatment, and while cultures are important, they should not postpone initial resuscitation. Starting IV fluids and monitoring BP are important, but they come after ensuring airway, breathing, and rapid support are underway.