A child arrives severely dehydrated: what do you do?

Every clinical panel asks one emergency case: for nurses and CHWs a child with severe dehydration or fast breathing, for midwives a woman bleeding after delivery, for nutrition staff a child with oedema who refuses to eat. The panel is not testing whether you can recite the protocol. It is testing whether you assess before you treat, follow the protocol for your level, call for help early, and keep the family and the record with you. Answer in five steps, in this order: assess, act, escalate, communicate, document.

1. 1Assess in the first minute. General danger signs first: unable to drink, vomits everything, convulsions, lethargic or unconscious. Then the dehydration signs: sunken eyes, skin pinch going back very slowly, drinking poorly. Two of these means severe dehydration. Check MUAC and oedema too: a severely malnourished child is rehydrated differently, and the panel wants to hear you know it.
2. 2Act by the protocol for your level. In IMCI this child is Plan C: intravenous Ringer's lactate, 100 ml per kg with the timing for the child's age, ORS by mouth as soon as he can drink, a nasogastric tube if you cannot get a line, and zinc once he is drinking. Reassess every 15 to 30 minutes. If your post cannot give IV fluids, the right answer is ORS by sips, an urgent referral and the mother giving ORS on the road.
3. 3Escalate while you act, not after. Call the doctor on duty or the senior nurse using SBAR: situation (“two-year-old, severe dehydration”), background (“diarrhoea two days, MUAC 12.8”), assessment (“Plan C, lethargic, pulse 160”), recommendation (“I am starting the line, please come now”).
4. 4Communicate with the mother in plain Somali: what is wrong, what you are doing, and what you need from her (hold him, give the ORS, tell you if he vomits). A calm mother is your second nurse; a frightened one may take the child home.
5. 5Document as you go: arrival time, weight, the signs found, fluids and rate, when you called and who came, every reassessment. If it is not written, the next shift and the panel treat it as not done.