امرأة عمرها ٧٩ سنة عندها قسطرة بولية دائمة، جاءت بتشوش وحرارة ٣٩٫٠ ورجفة. الضغط ٨٤/٤٨، والنبض ١٢٤، والتنفس ٢٦، واللاكتات ٤٫١. البول عكر. ما الإجراء الأولوية؟

A 79-year-old woman with a long-term urinary catheter presents with confusion, fever 39.0 °C and rigors. BP 84/48, HR 124, RR 26, lactate 4.1; urine is cloudy. What is the priority?

1. Oral antipyretic and reassess in two hours
2. Blood cultures, then IV antibiotics within an hour with rapid fluids
3. Change the catheter first, then await the urine culture
4. Keep her nil by mouth and restrict fluids to protect the heart

Answer: B) Blood cultures, then IV antibiotics within an hour with rapid fluids. This is septic shock from a urinary source. Priorities: blood cultures, IV antibiotics within an hour, 30 mL/kg fluids and lactate monitoring. The catheter is changed without delaying treatment.