A patient with fever, tachycardia, hypotension, and elevated lactate. What is the initial management?

• A. Initiate sepsis protocol: obtain cultures, start broad-spectrum antibiotics, and administer IV fluids
• B. Provide analgesia and observe
• C. Place on oxygen by nasal cannula only
• D. Administer diuretics

Answer: (A)

When a patient presents with fever, tachycardia, hypotension, and elevated lactate, think sepsis with possible septic shock. The priority is rapid stabilization and empiric treatment to control infection and restore perfusion. Initiating a sepsis protocol at once is the best approach: obtain blood cultures before antibiotics if feasible, start broad-spectrum antibiotics promptly (ideally within an hour of recognition), and begin aggressive IV fluid resuscitation to improve circulating volume and organ perfusion (crystalloids are typically used, with a common initial target of about 30 mL/kg). Oxygen should be provided as needed to maintain adequate saturation, but simply giving analgesia, observing, or using diuretics without addressing the infection and perfusion is not appropriate in this scenario. This combination tackles both the source control aspects and the hemodynamic instability that sepsis causes, which is why it’s the most effective initial management.