Expected Action	Teaching Point	Result
Recognize septic shock (& etiology)	In a hypotensive, tachycardic patient with fever, strongly consider septic shock	The history provided with shock would suggest a complicated abdominal process, such as ischemic bowel due to bowel obstruction due to intussusception
Give rapid fluids	The patient should receive up to two isotonic intravenous boluses (20 cc/kg) with a reassessment of the patient’s hemodynamic status after each bolus	20 cc/kg → SBP 75mmHg 40 cc/kg → SBP 80 mmHg
Give antibiotics early	Necessary intervention for treating septic shock The presumed source for this patient is ischemic bowel from small bowel obstruction. Antibiotics should cover against a broad spectrum of pathogens but especially gram negative bacteria	One recommendation: Ceftriaxone (25–50 mg/kg q24h) and metronidazole (15 mg/kg, then 7.5 mg/kg q12h) Improved SBP to 80mmHg
Reassess after IV fluid boluses and antibiotics	Always recheck vitals, perfusion, respiratory status, and mental status after performing interventions in a critically ill patient	Improved vital signs, but not within normal limits
Recognize continued hypotension	Recheck vitals after every major intervention during resuscitation Consider vasopressor supports	Local vasopressor options vary, and nursing practices regarding routes of administration also vary PIVs can be used temporarily for vasopressor administration IOs are a rapid means of vasopressor administration