Pediatric Shock Part 4 Hemorrhagic Shock

Hemorrhagic Hypovolemic Shock

· Isotonic crystalloids 20ml/kg

· Repeat up to 3 boluses 60ml/kg if needed

· Give 3ml of isotonic crystalloids for each 1ml of blood lost

· PRBCs 10ml/kg boluses for hemorrhagic shock refractory to crystalloids

· Warm the blood to minimize hypothermic effects of transfusion

Mild Blood Volume Loss (<30%)

· Cardio: Tachycardia, thready peripheral pulses, BP may be normal

· CNS: Anxious, irritable, and confused

· Skin: Cool, mottled, prolonged capillary refill

· Urine output: Low to very low

Moderate Blood Volume Loss (30-45%)

· Cardio: Tachycardia, thready central pulses, absent peripheral pulses, low normal BP

· CNS: Lethargic, dulled response to pain

· Skin: Cyanotic, marked prolonged capillary refill

· Urine output: Minimal

Severe Blood Volume Loss (>45%)

· Cardio: Tachycardia followed by bradycardia, hypotensive, widened pulse pressure

· CNS: Comatose

· Skin: Pale and cold

· Urine output: None

Source

Float Nurse