In septic shock managed per Surviving Sepsis Campaign 2021 guidelines, the initial vasopressor of choice when MAP <65 mmHg despite adequate fluid resuscitation is:

• A Dopamine
• B Adrenaline (epinephrine)
• C Phenylephrine
• D Noradrenaline (norepinephrine) ✓

Explanation

Noradrenaline (norepinephrine) is the first-line vasopressor in septic shock per SSC 2021 guidelines, as it has predominant α1-agonist activity restoring vasomotor tone with minimal β1 chronotropic effects. Dopamine is associated with increased arrhythmia risk and should not be used as first-line. Vasopressin (0.03 U/min) is added as second-line to spare noradrenaline dose. Adrenaline is reserved for refractory cases or cardiac arrest. Phenylephrine is used when tachyarrhythmias preclude noradrenaline use.

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

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Written and medically reviewed by the StethoPrep medical team.