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?
Keep going — a set of ten like this one, one at a time.
Practise moreMore from Paediatrics
See allA couple attend for genetic counselling. Their 3-year-old son has cystic fibrosis, confirmed by newborn screening and genotyping; both parents are carriers of a…
Foundations · common
A 10-day-old boy born at term is brought in with two days of poor feeding, vomiting and lethargy, and today is floppy and grey. He is afebrile, with a heart rat…
Clinical rotations · niche
A 2-year-old boy weighing 12 kg has had two days of vomiting and profuse watery diarrhoea. He is now floppy and barely responsive, with cool mottled legs, a cap…
Clinical rotations · common
A 9-month-old girl was eating grapes when she suddenly began to struggle. When you reach her she is conscious, silent, not crying and not coughing, with her mou…
Clinical rotations · common
A 3-year-old girl has refused to walk or stand since waking this morning and screams when her right leg is moved. She had a cold last week. Her temperature is 3…
Pre-internship · common