Red flags
- Grunting, retractions, lethargy, mottled skin
- Capillary refill >3s
First steps
- Pediatric Assessment Triangle
- Weight (kg) → drug & fluid calculations
- Glucose, temperature
Key investigations
- CBC, CRP, blood culture if febrile <3 mo
- Urine, CXR as indicated
Differentials
- Bronchiolitis, croup, asthma, pneumonia
- Sepsis, meningitis, gastroenteritis with dehydration
Initial management
- Oxygen to SpO₂ ≥94%
- Fluid bolus 10–20 ml/kg isotonic if shock
- Antibiotics within 1 h if sepsis suspected
- Salbutamol MDI 4–10 puffs via spacer for wheeze
Referral
- Paediatric ICU
- Paediatric specialist
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