Expected Action	Teaching Point	Result
Diagnose hypovolemic shock	A patient with large-volume diarrhea with resultant hypotension, lethargy, tachycardia, and cool skin suggests hypovolemic shock.	Patient is in shock from severe dehydration and poor oral intake.
Evaluate for malnutrition	Dehydration and malnutrition can present similarly. One should inquire to the normal appearance of the child with the caretaker. Edema, wasting, or decreased upper arm circumference are the easiest ways to identify malnutrition in the acute setting.	This child’s presentation is more suggestive of dehydration than malnutrition.
Estimate weight	An age-based or height-based system for systemic estimation of weight is indicated for appropriate pediatric weight-based dosing.
Give parenteral fluids	The treatment of hypovolemic shock is aggressive fluid resuscitation. Rapid bolus, 20 mL/kg push over 5 min or less. Only isotonic fluids should be given as a bolus (e.g., ringer’s lactate or normal saline). If evidence of malnutrition, 10 mL/kg bolus.	20mL/kg × 6kg = 120mL initial fluid bolus
Clear communication	Has one person been designated the “team lead?” Is there closed-loop communication? When the leader gives a clear request, and second team member recites back the interpretation of the request and completion of the request. Mental modeling. The team leader shares his/her thought process for greater group understanding of the resuscitation. (e.g., “I think this patient has hypovolemic shock and so we will treat with IV fluid boluses.”	The team should each reflect their roles as members of the team and how communication can be improved.