Pediatric Shock Part 2 General Management

General Management of Shock

·         Positioning

·         Airway and breathing

·         Vascular access

·         Fluid resuscitation

·         Monitoring

·         Frequent reassessment

·        Diagnostic studies

·         Pharmacological therapy

·         Expert consultation

Positioning

·         Stable- allow to remain with caregiver in a position of comfort

·         Unstable- Trendelenburg if hypotensive

Airway and Breathing

·         High concentration oxygen via NRB mask

·         Consider transfusion if low blood count

·         Consider ventilator, CPAP, or noninvasive positive airway pressure

Vascular Access

·         Peripheral IV if possible

·         Consider IO access
·         Consider central line

Fluid Resuscitation

·         Isotonic crystalloids 20ml/kg over 5-20 minutes

·         Repeat boluses as needed

·         Colloids or PRBCs if needed

·         Decrease volume and rate with myocardial dysfunction

Monitor

·         SpO2

·         Heart rate

·         Blood pressure

·         Level of Consciousness

·         Temperature

·         Urine output

·         SVO2

Frequent Reassessment

·         Evaluate response to interventions

·         Reevaluate hemodynamic  trends

Conduct  Diagnostic Studies 

·         Identify etiology of shock

·         Evaluate end organ dysfunction

·         Identify metabolic abnormalities

·         Evaluate response to interventions

Pharmacological therapy

·         Improve cardiac output

·         Reduce or increase SVR

·         Improve end organ perfusion

·         Correct metabolic abnormalities

·         Manage pain and anxiety

Expert consultation

•        Recognize limitation

•        Enlist help of other subspecialties

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)