Expected Action	Teaching Point	Result
Rapid assessment of airway, breathing, and circulation	When presented with ill patient, assess early, and immediately intervene if emergent situation found	This patient’s circulatory status is unstable: tachycardia, hypotension, delayed capillary refill
Check vital signs and recognize abnormal vital signs	Document initial vitals HR for age – greater than 130bpm is abnormal SBP for age – less than 75mmHg is abnormal
Obtain IV/IO access for resuscitation	Try PIV first, particularly if the patient is awake. Strongly consider IO if critically ill and unable to obtain PIV, particularly if altered mental status/coma.	If re-doing round, can make PIV unattainable: those who are expected to place an IO may practice. Those who are not, can consult someone who is proficient.
Take basic history from the patient	History is important to management and should not be neglected even if the child is critically ill. This will guide management. Try to obtain information while performing other tasks.	The history provided suggests an acute abdominal process. The intermittent nature of the abdominal pain and the changes of the quality of stool suggest complicated intussusception
Recognize septic shock (and etiology)	The patient meets SIRS criteria with likely intraabdominal source for septic shock