Still in Shock: A Terrifying Tale of Refractory Hypotension

Initial History/Presentation: Previously healthy 12-year-old female presenting after a witnessed 2 minute syncopal event in the setting of 1 week of nausea and abdominal pain. Physical exam: By ED arrival, she had returned to full consciousness. She was afebrile, mildly tachycardic with a HR of 109, and hypotensive to 84/43. Her exam was normal other than mild tenderness over the left scapula and epigastrium. Diagnostic Evaluation: Her lab work was significant for an elevated lactate, mild leukocytosis, …