A 55-year-old postoperative patient develops hypotension (BP 85/50), tachycardia (HR 128), warm peripheries, SpO2 94% on room air, and lactate 4.2 mmol/L after abdominal surgery. Cultures are sent. The Surviving Sepsis Campaign (2021) mandates which intervention within 1 hour?

• A Blood cultures, IV antibiotics, and vasopressin as first-line vasopressor
• B Immediate CT abdomen to identify source before antibiotics
• C Central venous catheter insertion for CVP-guided fluid therapy
• D Broad-spectrum antibiotics + 30 mL/kg crystalloid bolus + blood cultures ✓

Explanation

The Surviving Sepsis Campaign 2021 Hour-1 Bundle mandates: (1) blood cultures before antibiotics, (2) broad-spectrum antibiotics within 1 hour, (3) 30 mL/kg IV crystalloid for hypoperfusion, (4) norepinephrine for MAP <65 mmHg not responding to fluids, (5) lactate measurement (if >2 mmol/L, remeasure). The bundle emphasizes early antibiotics without delaying for CT or obtaining central access. Vasopressin is added as a second-line vasopressor; norepinephrine is first-line. CVP-guided therapy has been abandoned as a resuscitation target.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.