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Check for cool and clammy extremities, a peripheral capillary refill time longer than 2 seconds, a rapid respiratory rate, decreased urine output, mottled skin, weak or absent peripheral pulses, decreased level of consciousness, and, in infants, sunken fontanels. Age Alert My colleague believes that blood pressure provides an adequate clinical indicator of perfusion in children. I disagree. Which one of us is correct? Perhaps. According to new classifications, this patient's blood pressure is classified as prehypertension.

The illustration at right shows where to position your fingers when palpating this pulse. Lightly place your fingers just medial to the trachea and below the jaw angle. Never palpate both carotid arteries at the same time. You may not be able to palpate radial, dorsalis pedis, or posterior tibialis pulses. If you can't, try palpating the more proximal pulses: brachial, popliteal, or femoral. And if you can't palpate these, try using a handheld Doppler device to detect pulses audibly. If you're concerned about reduced arterial circulation, be sure to assess color, warmth, and sensation in the extremities.

45% sodium chloride (half-normal saline solution) Hypertonic Dextrose 5% in half-normal saline solution Dextrose 5% in normal saline solution • Lower GI tract fluid loss • Acute blood loss • Hypovolemia due to third-space shifting doesn't contain magnesium. • Contains potassium; don't use with renal failure; can cause hyperkalemia. 5. • Water replacement • DKA after initial normal saline solution and before dextrose infusion • Hypertonic dehydration • Sodium and chloride depletion • Gastric fluid loss from nasogastric suctioning or vomiting • Use cautiously; may cause cardiovascular collapse or increased intracranial pressure.