Clinical starting point
Think through the case
A patient with septic shock remains poorly perfused after initial resuscitation and blood pressure support. Bedside assessment raises concern for cardiac dysfunction. What should guide the next reassessment?
Review the essentials
Open each section, then test your reasoning.
Reassess the circulation
Persistent hypoperfusion requires reassessment of volume status, arterial pressure, and cardiac function. Bedside echocardiography may help characterize dysfunction and guide the clinical assessment.
Avoid a single-number decision
Interpret cardiac findings alongside perfusion and the response to treatment. Continue evaluating infection management and other contributors to shock.
Consider targeted support
For persistent hypoperfusion with cardiac dysfunction despite adequate volume status and arterial pressure, the Surviving Sepsis Campaign conditionally suggests adding dobutamine to norepinephrine or using epinephrine alone. This is individualized critical care, not an automatic response to an echo finding.
Apply what you know
Knowledge check
0 of 3 answered
Source & learning scope
SCCM · Surviving Sepsis Campaign adult guidelines ↗
New standalone learning edition · Prepared October 22, 2026. Professional education; apply current guidance and local protocols. This focused lesson is not a complete treatment pathway.