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Case 07 · Infection and critical care

Septic shock (urinary source)

A 62-year-old woman with diabetes has had three days of fever, burning urine and right flank pain. Tonight she is confused, her blood pressure is 82/48 and her lactate is high. Run the hour-1 bundle, support her circulation without drowning her, and find the source that antibiotics alone cannot fix.

PlayableClinical review pendingIntermediateAbout 1–4 simulated hoursHindi · English · both
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About this case

What you will practise

Learning objectives

  • Recognise septic shock from suspected infection, hypotension and a raised lactate.
  • Complete the hour-1 bundle: lactate, cultures before antibiotics, a broad-spectrum antibiotic, fluid and a vasopressor.
  • Give balanced crystalloid in boluses and reassess, recognising when more fluid will not help.
  • Start noradrenaline early for a MAP below 65 mmHg, peripherally if needed, and escalate safely.
  • Find an obstructed, infected kidney and arrange urgent decompression.
  • Monitor urine output, lactate and glucose, and hand over to the ICU.

Key decisions this case tests

  • Cultures first, or antibiotics first, when time matters?
  • Which empirical antibiotic, given local resistance?
  • How much fluid, and when to stop?
  • When to start noradrenaline, and how to wean it.
  • Why is she not improving on antibiotics?

Reference basis

  • Evans L et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2021. Crit Care Med 2021;49:e1063–e1143.
  • Levy MM, Evans LE, Rhodes A. The Surviving Sepsis Campaign bundle: 2018 update. Crit Care Med 2018;46:997–1000.
  • Empirical antibiotics should follow the local antibiogram and national guidance (for example, ICMR antimicrobial treatment guidelines).

Content version 1.0 · November 2026 · clinical review pending. See the Clinical content policy.

Before you start

The physiology is a simplified teaching model: infection, vasodilatation, capillary leak and drug effects are timed for learning, not prediction. Doses follow the cited guidelines but have not yet been signed off by a clinician.

Visle is for education only and is not medical advice. Fever with confusion, fast breathing or low blood pressure needs urgent hospital care.

Ready for another emergency?

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