An 82-year-old woman is brought to a Canadian emergency department by her daughter because of 2 days of dysuria, fever, and increasing confusion. Today she is difficult to rouse. She has type 2 diabetes and hypertension and takes metformin, ramipril, and atorvastatin. She has no known drug allergies and weighs 60 kg. On examination she is drowsy with dry mucous membranes, suprapubic tenderness, and right costovertebral angle tenderness. Laboratory results: WBC 22.0 x 10^9/L (4.0-11.0), creatinine 188 umol/L (45-90; baseline 78), lactate 4.8 mmol/L (0.5-2.0). Urinalysis is nitrite positive with numerous leukocytes. A urinary catheter is inserted and drains 10 mL of cloudy urine.
| Heart rate | 124/min |
| Respiratory rate | 26/min |
| Temperature | 38.9 °C |
| O2 saturation | 94%, room air |
| Blood pressure | 82/46 mm Hg |
Question 1 of 3
Which of the following interventions should be started within the first hour?
Select 3. (0 / 3 selected)
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