In septic shock management, what is the typical initial vasopressor used to maintain MAP?

• A. Phenylephrine
• B. Norepinephrine
• C. Dopamine
• D. Epinephrine

Answer: (B)

In septic shock, after adequate fluid resuscitation, the goal is to restore mean arterial pressure to a level that ensures organ perfusion. Norepinephrine is the best initial vasopressor because it provides strong alpha-adrenergic vasoconstriction to raise systemic vascular resistance and MAP, while its beta-1 activity helps support cardiac output. This combination improves perfusion without the higher risk of tachyarrhythmias seen with dopamine, and without the potential for reduced cardiac output that pure alpha agonists like phenylephrine can cause. Epinephrine can be effective but tends to increase lactate and cause arrhythmias, so it’s usually reserved as an adjunct if norepinephrine alone doesn’t achieve the target.