Fluid bolus therapy and vasoactive support — branching viva

Stage 1 — The first bolus

The child weighs 18 kilograms. The heart rate is 165 per minute, capillary refill is 4 seconds, skin is cool and mottled, pulses are weak, blood pressure is 75/45 mmHg, and the child is drowsy but responsive. ^[4]

Examiner: "What is your immediate fluid management and why?" ^[2]

I confirm septic shock from the integrated assessment: tachycardia, prolonged capillary refill, weak pulses, mottled skin, hypotension and altered consciousness. I give 10 to 20 mL per kilogram of isotonic crystalloid — 0.9 per cent sodium chloride or Hartmann solution — over 5 to 20 minutes. For this 18 kilogram child, that is 180 to 360 mL per aliquot. Before giving it, I state the improvement I expect: heart rate falling toward normal, shorter capillary refill, stronger pulses, warmer skin and improved interaction. I do not give it as a slow gravity drip — I use a push-pull technique or rapid infuser. ^{[2] [3]}