Immediate Plan

1. Place the largest bore IV possible. If unable to obtain rapid IV access, an intraosseous (IO) needle should be inserted.

2. Immediate action consists of rapid infusion of at least 20 mL/kg of an isotonic solution (preferably normal saline or lactated Ringer). Aggressive and immediate fluid resuscitation is the cornerstone of management of hypotension. This requires at least 20-40 mL/kg of an isotonic solution that is pushed as rapidly as possible. If there is no response, or inadequate response, to initial fluid therapy, continue fluid boluses. Some patients may require as much as 100-120 mL/kg before stabilization occurs.

3. Administer oxygen to patient, support airway if needed, and place patient in Trendelenburg position (head 30 degrees below feet).

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