Fluid bolus therapy and vasoactive support — long case

Presentation

A three-year-old weighing 14 kilograms presents to a rural emergency department with fever for 12 hours, poor feeding, lethargy and a purpuric rash. The child is cool and mottled with weak central pulses, a capillary refill of 5 seconds, a heart rate of 175 per minute, a blood pressure of 68/42 mmHg and a reduced conscious state responding to voice. The hospital has intravenous access and crystalloid but no paediatric intensive care or vasoactive agents on site. Retrieval is available but transport time is 90 minutes. ^{[4] [9]}