What is the priority intervention in the early stages of septic shock?

• A. Rapid infusion of 30 mL/kg isotonic fluids
• B. Start vasopressors first
• C. Administer corticosteroids
• D. No fluids; observe

Answer: (A)

In septic shock, the priority is to restore intravascular volume to improve preload and tissue perfusion. The best initial move is rapid infusion of isotonic crystalloids, about 30 mL/kg, given promptly and reassessed soon after each bolus. This volume expansion increases cardiac output and helps reverse hypoperfusion of vital organs. If hypotension persists after adequate fluid resuscitation, vasopressors are started to maintain a mean arterial pressure of at least 65 mmHg. Corticosteroids are considered later if vasopressor requirements remain high or the patient remains hypotensive despite fluids and vasopressors. Choosing no fluids would allow ongoing poor perfusion, making it inappropriate.