In a 3-year-old child with cold septic shock, low cardiac output, and high systemic vascular resistance (SVR), which inotrope is recommended as first-line?
A
Noradrenaline infusion (0.05-0.5 mcg/kg/min)
B
Adrenaline infusion (0.05-0.3 mcg/kg/min)
C
Milrinone solo without vasoactive support
D
Pure Phenylephrine bolus
E
Dobutamine without fluid resuscitation
Solution:
According to ACCCM/PALS septic shock guidelines, cold shock with low cardiac output responds best to low-dose Epinephrine/Adrenaline (0.05-0.3 mcg/kg/min) due to its beta-1 inotropic and chronotropic activity.
