First Things First (assess and treat)

• Is there airway compromise?
  • Is there mucosal involvement? Are the lips or gums swollen?
  • Is there audible wheezing or stridor?
  • Is there tachypnea, grunting, flaring or retractions?
• Is there hemodynamic instability?
  • Is the patient hypotensive?
  • Does the patient have delayed capillary refill?
• Is this anaphylaxis?
• Assess ABCs and support accordingly.
• Once ABCs are stabilized, evaluate for neurologic disability and meningeal signs.
  • Consider meningococcemia early if a new rash preceded by mild upper respiratory infection is present in adolescent or college-age patients ± fever.