PALS | Management of Shock

1️⃣ Types of Pediatric Shock (Know These Cold)Hypovolemic 🩸: dehydration, hemorrhageDistributive 🌡️: sepsis (most common), anaphylaxis, neurogenicCardiogenic ❤️: congenital heart disease, myocarditisObstructive 🚫: tension pneumo, tamponade, PE2️⃣ Universal Signs of Shock (High Yield)Tachycardia (earliest sign)Delayed cap refill > 2 secCool, mottled, pale skinWeak or thready pulsesAltered mental statusOliguria / ↓ urine outputHypotension = late and pre-arrest3️⃣ General Management Principles (ALL Shock Types)A. Immediate Actions 🆘Call for help / PALS teamAirway & breathing: O₂ to maintain SpO₂ > 94%Cardiac monitor + large-bore IV/IO accessCheck glucose (treat <70 mg/dL)B. Fluid Resuscitation ⚡20 mL/kg isotonic fluid bolus (NS or LR)Give rapidly over 5–10 minReassess after each bolusCan repeat up to 60 mL/kg (except cardiogenic shock)4️⃣ Shock-Specific Management🩸 A. Hypovolemic Shock (Most Common)Problem: ↓ preload Treatment:20 mL/kg boluses x3Control bleedingTreat dehydration (fluids + electrolytes)Monitor for improvement: HR ↓, cap refill ↑🌡️ B. Distributive Shock (Septic, Anaphylactic, Neurogenic)1. Septic ShockProblem: vasodilation + capillary leak Treatment:20 mL/kg boluses (often large volumes needed)Broad-spectrum antibiotics within 1 hourVasopressors if fluid-refractory:Epinephrine or norepinephrineCorrect glucose & electrolytesWarm the child2. Anaphylactic ShockProblem: massive vasodilation + airway obstruction Treatment:IM Epinephrine 0.01 mg/kg (1:1000) ASAPAirway supportAlbuterol neb for wheezeIV fluidsDiphenhydramine + steroids (adjuncts)3. Neurogenic ShockProblem: loss of sympathetic tone Treatment:Judicious fluidsVasopressors (epi or norepi)Maintain spinal precautions❤️ C. Cardiogenic ShockProblem: ineffective pump DO NOT flood with large fluid boluses.ManagementSmall boluses: 5–10 mL/kgInotropes:EpinephrineDopamineMilrinone (afterload reduction)Correct arrhythmiasTreat myocarditis / congenital issuesConsider cardiology consult early