Correct!
3. Norepinephrine
The patient has dry gangrene from a myriad of causes to include possible hypothermia with potential frostbite injury, toxic shock secondary to group B Streptococcus, disseminated intravascular coagulopathy, and now with the addition of vasopressor support; potential vasospam. Group B Streptococcus has been shown to present with a toxic shock like syndrome (TSLS) from pyrogenic toxin(s) (2-4). The goal in therapy is to treat the underlying disease but preservation of the extremity is pivotal. In this case, continuation of norepinephrine with a plan to discontinue as soon as possible is the most appropriate plan (5). Phentolamine is incorrect as there is no evidence of pressor extravasation. There is limited evidence for the use of epoprostenol used solely as reversal for vasospasm. Dobutamine at this time is not a preferred vasopressor.
Once you receive speciation, what antibiotics should be added or augmented? (Click on the correct answer to proceed to the fifth and final page)