A 4-year-old after a motor vehicle crash presents hypotensive and tachycardic with poor capillary refill. Which intervention is indicated?

• A. dobutamine
• B. epinephrine
• C. sodium nitroprusside
• D. volume expanders

Answer: (D)

When a child who has had trauma is hypotensive with tachycardia and poor capillary refill, the primary issue is a reduced intravascular volume leading to hypovolemic shock. The best intervention is rapid volume expansion with isotonic crystalloids (volume expanders) such as normal saline or lactated Ringer’s solution, given as 20 mL/kg boluses and repeated as needed until perfusion improves. Restoring circulating volume increases preload and improves cardiac output, which directly improves tissue perfusion and stabilizes vital signs.

Vasopressors or inotropes are not the first step here because they don't replace lost volume and can worsen perfusion if given before adequate volume. For example, a vasodilator would further lower blood pressure, and an inotrope like dobutamine or a drug like epinephrine may be reserved for specific shock states after volume resuscitation. Sodium nitroprusside would lower blood pressure and is inappropriate in this setting. Thus, restoring volume with isotonic fluids is the indicated initial intervention.