A 20 month-old patient presents with a 3-day history of cough and fever. Her mother is concerned because she has been quite tired today, refusing to eat and drink, and has not had any wet diapers today. On examination she is alert but irritable. Her vital signs are as follows: HR 130 BP 95/60 T 38.5 RR 30. She has delayed cap refill. You make a presumptive diagnosis of sepsis. After 1 minute of trying, IV access cannot be established. What is the next best step?

About the Author: Anton Helman

Dr. Anton Helman is an Emergency Physician at North York General in Toronto. He is an Assistant Professor at the University of Toronto, Division of Emergency Medicine and the Education Innovation Lead at the Schwartz-Reisman Emergency Medicine Instititute. He is the founder, editor-in-chief and host of Emergency Medicine Cases.