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Septic shock — RACP Paediatrics MCQ

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HardEmergency paediatricsSeptic shockRACP Paediatrics

A 2-year-old has fever, grunting and reduced responsiveness. Heart rate is 180/min, capillary refill is 5 seconds and blood pressure is low; lactate is 5.2 mmol/L. What is the most appropriate management?

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Correct answer: A — Oxygen, rapid vascular access, fluid bolus and intravenous antibiotics

This child has septic shock and needs simultaneous oxygen, vascular access, cautious bolus resuscitation, cultures if feasible and prompt IV antibiotics. LP must not delay resuscitation and may be unsafe in shock. The pearl is that paediatric hypotension is a late sign, so prolonged capillary refill and altered mental state should trigger sepsis escalation.

Reference: RCH Clinical Practice Guidelines: Sepsis assessment and management; Therapeutic Guidelines (eTG): Antibiotic