PDF iconDiagram

  • Inadequate tissue perfusion → anaerobic metabolism → accumulation of lactic acid → metabolic acidosis
  • If acidosis is unrecognized → cell death, organ dysfunction, multi-organ system failure, and DEATH
  • Goal is to improve tissue oxygenation by increasing oxygen delivery and decreasing oxygen demand
  • Treat underlying process
  • EARLY RECOGNITION IS KEY!!!
  • Requires high index of suspicion
  • Tachycardia and tachypnea often 1st sign
  • Hypotension is a late finding in pediatrics

Etiology of shock

  • Hypovolemic - characterized by inadequate circulating intravascular volume, ex: hemorrhage, fluid loss
  • Cardiogenic - characterized by myocardial dysfunction, ex: arrhythmias, cong heart disease, myocarditis, cardiomyopathy
  • Obstructive - characterized by inability to produce adequate cardiac output despite normal intravascular volume, ex: tamponade, pneumothorax, outflow obstructions
  • Distributive - characterized by inadequate distribution of fluid volume, ex: anaphylaxis, spinal cord disruption, severe sepsis

General treatment principals

  • ABCs - Consider intubation to decrease O2 demand
  • Invasive lines often needed
  • Fluid Resuscitation - If unresponsive, widen DDx!
  • Vasoactive Infusions - Will provide CV support
  • Sedation/Paralysis - Will decrease O2 demand
  • Temperature Control
  • Antibiotics