PE24.{3,12-14} | Shock Emergency — Summary & Reflection

KEY TAKEAWAYS

Paediatric shock is circulatory failure causing inadequate tissue oxygen delivery. Hypotension is a late sign — diagnose shock on tachycardia, prolonged CRT (>2 s), poor perfusion, and altered mental status. The four types (hypovolaemic, distributive, cardiogenic, obstructive) have distinct mechanisms and management. Standard fluid resuscitation: 20 mL/kg isotonic crystalloid IV/IO over 5–20 minutes, repeated up to 60 mL/kg, reassessing after each bolus. Exceptions: 10 mL/kg in neonates and DKA; 5–10 mL/kg in cardiogenic shock. Peripheral IV is first; escalate to IO (proximal tibia) within 90 seconds if IV fails. Vasopressors (dopamine, noradrenaline) are added if fluid-refractory after 60 mL/kg. Bradycardia in a shocked child is preterminal. Always check blood glucose concurrently — hypoglycaemia worsens outcome.

REFLECT

Think about a child with diarrhoea and vomiting you have seen on a ward or outpatient visit. Using what you now know, classify their degree of dehydration and estimate whether they were in compensated shock or pre-shock. Were the fluid volumes given appropriate? Was an IV or IO line placed? Reflect on the cognitive challenge of calculating 20 mL/kg in your head under time pressure — what mental shortcut could you develop (e.g., round the weight to the nearest 5 kg, then multiply) to speed this up? How would you confidently identify the IO landmark on a real child's tibia, and what is the one most common error you would need to self-monitor for during insertion?