Pediatric Shock Part 1 Introduction

Shock

Clinical condition in which tissue perfusion is inadequate to meet the metabolic demands

Shock

·         Inadequate blood volume or inadequate oxygen-carrying capacity of blood

·         Inappropriately distributed blood volume

·         Impairment in heart contractility

·         Obstructed blood flow

Assessment

·         General appearance

·         Respiratory rate and depth

·         Mucus membranes

·         Cardiovascular- BP, HR, peripheral pulses

·         Neuro- mental status

·         Skin- color, temperature, capillary refill, turgor

·         Kidneys- urine output

Assessment- AVPU

·         Alert

·         Responsive to voice

·         Responsive to pain

·         Unresponsive

Identifying Hypotension

Age	Minimum SBP (mm Hg)
< 1 month	<60
1 mo- 1yr	<70
> 1yr	<70 + (2 x age in yrs)
>10 yr	<90

Note:  Hypotension develops when physiological attempts to maintain BP by increasing heart rate, cardiac contractility, and peripheral vascular tone are no longer effective.

Compensated Shock

If BP is normal but signs of poor perfusion are present, the child is in compensated shock

Signs of Compensated Shock

·         Tachycardia

·         Cool and pale distal extremities

·         Prolonged (2 seconds) capillary refill (despite warm

·         ambient temperature)

·         Weak peripheral pulses compared with central pulses

● Normal systolic blood pressure

Decompensated Shock

If hypotension is present with symptoms of poor perfusion, then the child is decompensated shock

Signs of Decompensated Shock

·         Depressed mental status

·         Decreased urine output

·         Metabolic acidosis

·         Tachypnea

·         Weak central pulses

·         Deterioration in color

Note:  Decompensated shock is characterized by signs and symptoms consistent with inadequate delivery of oxygen to tissues and inadequate end-organ tissue perfusion


Source

Pediatric Advanced Life Support Provider Manual by Leon, M.D. Chameides, Ricardo A., M.D. Samson, Stephen M., M.D. Schexnayder and Mary Fran, RN Hazinski (Oct 12, 2011)