New from Critical Care Medicine, Clinicians Corner explores a real patient case that has sparked debate. Review the case details, vote on how you would treat the patient, and after you submit, see how current poll results are trending. Then watch for an email on March 21 with access to the Critical Care Medicine article featuring two authors’ in-depth perspectives on the case.
Attending Congress? Join the Clinicians Corner presentation in SCCM Central on Tuesday, March 24, from 8:45 a.m. to 9:45 a.m. to hear directly from the article’s authors, gain deeper insight into their decision-making, and ask questions during the session. Log in and favorite this session now.
A 52-year-old woman presents to the emergency department with a 1- to 2-day history of fever, right flank pain, and nausea. Vital signs are: temperature 39.1 °C (102.4 °F), heart rate 130 beats/min, respiratory rate 22 breaths/min, and blood pressure 70/40 mm Hg. She has right costovertebral angle tenderness. Laboratory findings are: WBCs 15 × 103/μL, creatinine 1.9 mg/dL, and lactate 3.5 mmol/L. Urinalysis reveals many WBCs and few RBCs. CT reveals right hydronephrosis with an obstructing ureteral stone. She receives 2 L lactated Ringer solution and is started on norepinephrine and broad-spectrum antibiotics. Blood and urine cultures are pending. Urology plans intervention once the patient is stabilized. Despite increasing norepinephrine to 0.25 µg/kg/min, blood pressure remains low at 80/50 mm Hg.
Which of the following is the most appropriate next step?
