Action taken :

1. Immediately given antibiotics and 40 ml/kg albumin.
2. “Crash call” put out for PICU team.
3. Full set bloods taken.

Results:
WCC 2.4, Hb 10.5, pl 70.
Glucose 3.8
Na 149, K 3.4, Ca 2.1, Mg 0.4, PO₄ 1.6, urea 10.9, Creat 121.
HCO₃ 15, BE -7.
PT 30, APPT 75, INR 2.5.
Taken to PICU. Still shocked after 40ml/kg. Electively intubated and ventilated, Adrenaline started.  Commenced correction of acidosis, K, and Mg.

Extensive purpuric rash developed.

PICU consultant called in to supervise care.

10 month old boy. Taken to GP with h/o sudden onset of fever, vomiting and lethargy for 4 hours. Mother very anxious about child. GP referred child to walk-in clinic at hospital.

History on admission: Feverish and drowsy – sudden onset. 2 episodes of vomiting, 1 soft stool, no rash.

Assessment on admission: Drowsy and pale, dark rings around eyes.
Temp 37.7
CVS: P 181, BP 120/52, CRT 4 secs. Child peripherally shutdown.

RS: RR 32 breathing laboured and child cyanosed.
SaO2 100% in oxygen.
NS: GCS10 then 9, no neck stiffness.

Fine blanching rash on abdo/chest. 1 petechial spot on abdo.

Diagnosis: meningococcal septicaemia