Shock Scenario - 6 week old feeding poorly

Exam

Fatigued-looking small child, breathing rapidly but comfortably, slightly mottled extremities.

Temp 36.8 Pulse 165 Respirations 48 Blood pressure: Your Dinamap device is not picking up

Lungs: good air entry, some bibasilar crackles Cardiovascular: regular rhythm and rate, grade III/VI systolic murmur, loudest over LLSB, weak peripheral pulses, moderate central pulses Click below to hear the exam (although not accurate for rate) HEART EXAM Abdomen: soft, liver edge palpable 4cm below right costal margin, and spleen tip is palpable

What do you want to do first?

Check a chest Xray

Assess adequacy of airway and breathing

Begin treatment

Heart Exam sounds come from Synapse Publishing, Inc.