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[Correspondence] Decoding vital signs during triage: pulse pressure in children – Author’s reply

I thank Frederick Burkle and James Geiling for their Correspondence about my Comment.1 The point they raise about narrow pulse pressure in children is important. The WHO guidelines2 specify the clinical features most commonly seen when there is a narrow pulse pressure (eg, cold extremities, weak pulse, and slow capillary refill). WHO has not focused on the measurement of blood pressure to identify shock, for exactly the reason that is stated in the Correspondence: that shock (ie, cardiovascular impairment leading to reduced tissue oxygenation) can be present with a normal systolic and mean blood pressure.