After fluid resuscitation and administration of acetaminophen, which is the most appropriate next intervention for a 6-year-old female who remains hypotensive?

In the context of a 6-year-old female who remains hypotensive despite fluid resuscitation and acetaminophen administration, initiating epinephrine at a rate of 0.05 mcg/kg/min IV is the most appropriate next intervention.

Epinephrine is a catecholamine that acts as a potent vasopressor and can help increase peripheral vascular resistance, thereby improving blood pressure in a hypotensive patient. After initial fluid resuscitation, if hypotension persists, the next step often involves pharmacologic support to stabilize hemodynamics. Epinephrine, along with other vasopressors, is typically indicated in pediatric patients experiencing shock who do not respond adequately to fluid therapy.

In contrast, continuing acetaminophen does not address the underlying issue of hypotension, as it serves primarily for analgesia and fever reduction rather than hemodynamic support. Administering more normal saline bolus may be considered under certain circumstances, but given that the patient has already undergone fluid resuscitation, adding more fluid could lead to volume overload without resolving the low blood pressure.

Stopping all medications and reassessing may not be prudent in the context of ongoing hypotension, as this delay could result in worsening clinical status. Therefore, the initiation of ep