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Meningococcal septicaemia — MRCPCH FOP MCQ

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HardInfectious diseasesMeningococcal septicaemiaMRCPCH FOP

A 14-month-old girl is febrile, drowsy and has a non-blanching purpuric rash. Capillary refill is 5 seconds, pulse is 180/min and blood pressure is low for age. What is the most appropriate management?

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Correct answer: E — High-flow oxygen, fluid bolus and immediate intravenous ceftriaxone

Shock with fever and purpuric non-blanching rash is meningococcal sepsis until proven otherwise, requiring immediate resuscitation and intravenous antibiotics. Lumbar puncture should not delay antibiotics and is unsafe in shock. Antihistamine is inappropriate because purpura and circulatory compromise are red flags. The pearl is that absence of neck stiffness does not exclude meningococcaemia.

Reference: NICE NG254 Suspected sepsis in under 16s; APLS