A 6-year-old boy in septic shock has received 60 mL/kg isotonic saline boluses with minimal improvement. His BP is 60/40 mmHg, HR 170/min, CRT >5 seconds, and he remains confused. The next intervention per current PALS guidelines (FEAST trial informed) is:

• A Start dopamine 5 mcg/kg/min and reassess
• B Give an additional 20 mL/kg crystalloid bolus
• C Give albumin 20 mL/kg as colloid rescue bolus
• D Initiate norepinephrine for warm shock and epinephrine consideration for cold shock ✓

Explanation

After 40-60 mL/kg fluid resuscitation without improvement, vasoactive agents are indicated. Norepinephrine is first-line for warm (vasodilatory/distributive) shock due to its predominant vasoconstrictive alpha action; epinephrine is first-line for cold shock with poor cardiac output. The FEAST trial demonstrated excess mortality with liberal bolus therapy in resource-limited settings, influencing guidelines to limit boluses. Dopamine is now second-line and albumin is not preferred over crystalloid in pediatric septic shock.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.