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CHAPTER 10 ■ SHOCK
FRAN BALAMUTH, JULIE C. FITZGERALD, SCOTT L. WEISS
DEFINITION OF SHOCK
Normal circulatory function is maintained by a complex interplay between the
central pump (heart) and blood flow at the regional level (microcirculation) for
the purpose of delivering oxygen and nutrients to tissues and removing metabolic
by-products (e.g., carbon dioxide). Shock can be defined as an acute syndrome of
cardiovascular insufficiency in which the circulatory system fails to provide
adequate oxygen and nutrients to meet the metabolic demands of vital organs,
resulting in cellular/metabolic dysfunction. This definition recognizes that shock
can and does exist without hypotension, especially in children, and that
inadequate cellular metabolism of oxygen and nutrients contributes to the clinical
manifestations and outcomes observed in patients with shock.
GOALS OF EMERGENCY THERAPY
All physicians who care for ill children will be faced with managing the clinical
syndrome of shock. Many common childhood illnesses, such as trauma,
gastroenteritis, infection, and accidental drug ingestions, can lead to shock.
Ultimately, without timely medical intervention, the child in shock will follow a
common pathway to multiorgan system failure and death. Early recognition and
appropriate therapy are vital to reduce the morbidity and mortality associated
with this serious syndrome.
The goals of emergency therapy in pediatric shock are threefold:
Prompt recognition
Shock reversal
Transfer to definitive care
This chapter is devoted to addressing each of these goals in turn. We begin with
a discussion of clinical and pathophysiologic considerations in pediatric shock,
followed by a description of different etiologic types of shock including
hypovolemic, cardiogenic, obstructive, distributive, and dissociative shock ( Fig.