A 58-year-old man develops septic shock secondary to community-acquired pneumonia. Despite 30 mL/kg crystalloid resuscitation, his MAP remains 55 mmHg. According to the Surviving Sepsis Campaign guidelines, which vasopressor is recommended as first-line therapy?
- A Dopamine
- B Norepinephrine ✓
- C Epinephrine
- D Vasopressin
Correct answer: B. Norepinephrine
Explanation
Norepinephrine is the recommended first-line vasopressor in septic shock per Surviving Sepsis Campaign guidelines. It has predominant alpha-adrenergic effects with minimal chronotropic effects, effectively raising MAP without significantly increasing heart rate. Dopamine is associated with higher arrhythmia mortality and is no longer preferred as first-line. Epinephrine is second-line when additional vasopressor support is needed. Vasopressin is an adjunct, not first-line.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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