Paediatricscommon
A 3-year-old girl is brought to a rural general practice, two hours by road from the nearest hospital, with 12 hours of fever, vomiting and increasing drowsiness. Her temperature is 39.6 °C, heart rate 165/min, and capillary refill 4 seconds. She is difficult to rouse. There are several purple spots on her legs and trunk that do not fade when a glass is pressed on them, and two are enlarging as you watch. The practice has intravenous and intramuscular antibiotics, oxygen and intravenous fluids but no laboratory.
Which one of the following is the most appropriate immediate management?