Question: The IV Therapy Medical Directive lists hypotension as a required indication for a fluid bolus. In pediatric medicine, blood pressure is rarely used alone as an indication of perfusion and tends more to rely on looking at the overall presentation including: level of awareness/activity, heart rate, capillary refill etc.
If presented with a child who is: irritable, tachycardic (or bradycardic for that matter), with delayed cap refill, and decreased urine output, but is not hypotensive (<5th percentile), is it permissible to administer a fluid bolus?
Great job recognizing that there are many signs of hypoperfusion in the pediatric population beyond hypotension (for what its worth, many adults with clinically significant hypoperfusion will also have many of the above signs).
The medical directive for administering IV fluid therapy requires a patient to be hypotensive prior to the administration of a fluid bolus. However, if you have a strong clinical suspicion that a patient may be hypoperfusing, for example in suspected sepsis, then it would be reasonable to initiate a patch to a BHP to discuss the role for IV fluids.