Shock in Children: Diagnosis and Initial Management
Shock is a state of inadequate tissue perfusion and oxygen delivery. It is a clinical diagnosis; hypotension is a late sign in children and indicates decompensated shock.
1. Early Clinical Recognition
Before blood pressure drops, look for signs of compensated shock:
- Tachycardia: The most common early sign.
- Perfusion: Delayed capillary refill (> 2 seconds), cool/mottled extremities, and weak peripheral pulses.
- Mental Status: Irritability, anxiety, or lethargy (reflecting poor cerebral perfusion).
- Urine Output: Oliguria (< 1 mL/kg/hour).
2. Initial Management Strategy
| Step | Action |
|---|---|
| Airway/Breathing | Ensure patency; provide high-flow oxygen. |
| Circulation (Fluid) | Isotonic crystalloid bolus (20 mL/kg) over 5–10 minutes. Repeat as needed based on assessment. |
| Monitoring | Continuous HR, RR, SpO2, and frequent BP monitoring. |
3. Types of Shock (Brief Overview)
- Hypovolemic: Most common (dehydration, hemorrhage). Low CVP.
- Distributive: Sepsis/Anaphylaxis (warm shock initially). Normal/High CVP.
- Cardiogenic: Pump failure. High CVP. Requires inotropic support, not just fluids.
- Obstructive: Tension pneumothorax, Tamponade.
NEET PG Hint: Never wait for hypotension to diagnose shock. Remember the PALS (Pediatric Advanced Life Support) rule for fluid bolus: 20 mL/kg is the standard initial bolus for most types of shock, but use caution (5–10 mL/kg) in suspected cardiogenic shock to avoid volume overload. Always evaluate for hypoglycemia, as it can mimic or exacerbate shock symptoms.