Fever and Worsening Perfusion in the Pediatric Emergency Department

You are leading the care team in the pediatric emergency department. A 5-year-old child weighing 18 kg has had a high fever and increasing lethargy since yesterday. The parent reports that the child has urinated only once today and has had no major vomiting, diarrhea, bleeding, or known heart disease.

The child opens their eyes to speech but interacts less than usual. The airway is open, breathing is spontaneous without retractions, respiratory rate is 30/min, and oxygen saturation is 96% on room air. Heart rate is 154/min, blood pressure is 94/56 mm Hg and within the expected range for age, temperature is 40.1 degrees Celsius, the skin is warm and flushed, capillary refill is brisk, and peripheral pulses are bounding.

A nurse and respiratory therapist are present. Monitoring, oxygen and ventilation equipment, IV and IO supplies, isotonic crystalloid, emergency medications, antimicrobial therapy, and pediatric critical care consultation are available.