Do not perform lumbar puncture; nil by mouth

  • ABC and high flow oxygen (minimum 10 l/min) by face mask
  • Insert 2 large IV cannulae (or IO). 
    • Take bloods for blood gas (bicarb, base deficit), lactate, glucose, FBC, U&E, Ca++, Mg++, PO4, clotting, CRP, blood cultures, whole blood (EDTA) for PCR, x-match.
    • Take Throat swab.
    • If limited blood volume, prioritise blood gas, lactate, glucose, electrolytes, FBC, clotting.

Volume resuscitation:

  • Immediate bolus of 20 ml/kg of 0.9% saline over 5-10 minutes and reassess immediately
  • If shock persists immediately give second bolus of 20 ml/kg of 0.9% Saline or of 4.5% human albumin over 5-10 minutes and reassess immediately
  • Observe closely for response / deterioration
  • Consider urinary catheter to monitor output

After 40 ml/kg fluid resuscitation are there still signs of shock?

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