Pediatric emergency medicine trisk 0292 0292

The keys to treating the child with shock are (1) early recognition of
shock, (2) aggressive treatment to rapidly reverse shock, and (3) rapid
diagnosis and correction of the underlying cause of shock. The
principles described in this chapter are broadly applicable to children
with various causes of shock and comprise the basic management
strategies for emergency stabilization. The most common pitfalls in
emergency stabilization of the child with shock are the following:
Delayed recognition of shock. Shock is a state of decreased tissue
perfusion resulting in cellular/metabolic dysfunction, but hypotension
does not need to be present and is a late finding in children.
Incomplete reversal of shock etiology. The underlying cause of shock
must be sought expeditiously and treated to ultimately reverse shock.
Important considerations are hemorrhagic shock in which the source of
bleeding must be controlled, the use of epinephrine for anaphylactic
shock, early antibiotics for septic shock, and caution with fluid
administration in cardiogenic shock.
Delayed establishment of vascular access for fluid and medication
administration. If peripheral IV access cannot be obtained rapidly,
intraosseous access should be obtained and used until definitive
access is obtained.
Suggested Readings and Key References
Arlt M, Philipp A, Voelkel S, et al. Extracorporeal membrane oxygenation in
severe trauma patients with bleeding shock. Resuscitation 2010;81(7):804–809.
Balamuth F, Alpern E, Abbadessa MK, et al. Improving recognition of pediatric
severe sepsis in the emergency department: contributions of a vital sign based
electronic alert and bedside clinician identification. Ann Emerg Med
2017;70(6):759–768.
Balamuth F, Weiss SL, Neuman MI, et al. Pediatric severe sepsis in US children’s
hospitals. Pediatr Crit Care Med 2014;15(9):798–805.
Carcillo JA, Davis AL, Zaritsky A. Role of early fluid resuscitation in pediatric
septic shock. JAMA 1991;266(9):1242–1245.

Choong K, Bohn D, Fraser DD, et al. Canadian Critical Care Trials Group.
Vasopressin in pediatric vasodilatory shock: a multicenter randomized
controlled trial. Am J Respir Crit Care Med 2009;180(7):632–639.