Pediatric Shock Management

A 3-year-old boy from rural Maharashtra presents to the emergency department with a 2-day history of diarrhea and vomiting. On examination, he is lethargic, has sunken eyes, skin turgor loss, weak pulses, and cold extremities. Capillary refill time is 4 seconds. Blood pressure is 70/40 mmHg. What is the most appropriate immediate next step in management?

A 5-year-old girl from Delhi presents with a 3-day history of fever, cough, and rapid breathing. On examination, she is irritable, has a respiratory rate of 52/min, intercostal retractions, and a capillary refill time of 3 seconds. Pulse is 140/min, blood pressure is 85/50 mmHg, and oxygen saturation is 88% on room air. Chest auscultation reveals bilateral crackles. A rapid diagnostic test confirms influenza A. What is the most appropriate immediate next step?

Which of the following is the most common cause of septic shock in children in India?

A 5-year-old girl from Delhi is brought to the emergency department with a 3-day history of high fever, cough, and rapid breathing. On examination, she is irritable, with a respiratory rate of 52/min, intercostal retractions, and grunting. Blood pressure is 88/56 mmHg (low for age), heart rate 156/min, and capillary refill time is 2.5 seconds. Extremities are warm. Oxygen saturation is 88% on room air. Blood culture is pending. What is the most likely type of shock, and what is the immediate next step?

A 3-year-old child presents to the emergency department with severe dehydration and hypotension (systolic BP 60 mmHg) following 3 days of acute gastroenteritis with profuse diarrhea. After rapid assessment, 20 mL/kg bolus of normal saline is initiated. Despite fluid resuscitation, the child remains hypotensive with poor perfusion, weak pulses, and altered mental status. What is the drug of choice for inotropic support in this case of refractory hypovolemic shock?