So it's clear Marley is a 'big sick'

The crew decide that it is more likely that he is suffering from a chest infection and that this is causing his symptoms. They have recognised that he fits the big sick category for a number of reasons.

These reasons include, low oxygen saturations, there is still respiratory distress with tachypnoea and grunting, mild recession but no prolonged expiration. They have decided to give a nebuliser before loading him into the ambulance.

In some cases it’s really easy to notice a shocked patient, they look really sick, they’ll be tachycardic, they’ll be tachypnoeic, they’ll be pale, they’ll be sleepy. Anyone who seen a few children will look at that and be alerted that that child is really sick. Early stages things can be a bit blurred than that, so a hot child can be tachycardic and tachypnoeic they could be miserable, they could be tired and sleepy. That may be early stage of sepsis. But in some situations it may not be that obvious, the child who’s hot with a fever may be tachycardic or tachypnoeic. Maybe they look unwell, you give them something to bring their fever down and they’ll start to look a lot better. So you’ve got to be alert to it. You’ve got to be alert to the possibility that your tachycardic or tachypnoeic child could actually be at the early stages of something more significant. And being alert to the possibility means that you’re not going to be miss the child who either doesn’t get better or deteriorates.

Remember blood pressure will be normal in a septic child and until they become really unwell, and is often a very late sign, but if the blood pressure is low, you really got to be considering that his child has the signs of sepsis and get on the start to treating.