PALS: SHOCK

Question 1

4 Categories of shock

Answer 1

Sepsis
Hypovolemia / Hemorrhagic
Obstructive
Cardiogenic
anaphylaKtic
Endocrine

Question 2

Signs of compensated shock

Answer 2

Altered Mental Status: irritability or decreased LOC

Altered Perfusion: prolonged or flash capillary refill
cool or warm extremities
mottled skin or pallor
weak peripheral pulses
Decreased Urine output

Tachycardia, less commonly bradycarida

Narrowed pulse pressure

Altered Temperature: fever or hypothermia

Question 3

Signs of decompensated shock

Answer 3

Hypotension

Question 4

Initial Stabilization

Answer 4

Monitor
Oxygen
Vitals
IV / IO
ECG / Airway Equipment

Rapid boluses of isotonic crystalloid IV fluids
Min 3 boluses of 20 ml / kg over 5-10 min each
Re-evaluate after each bolus

Question 5

Goals of Therapy

Answer 5

Improved mental status
Improved BP
Improved HR
Normal and equal central and peripheral pulses
Improved capillary refill < 2 seconds
Warming extremities
Improvement in important laboratory studies (e.g. Lactate Level)

Question 6

Dosing of pRBC

Answer 6

10 mL / kg

Question 7

Formula 50th systolic blood pressure in children ages 1 to 10

Answer 7

[2x(age)] + 90

Question 8

Initial labs

Answer 8

POC Glucose
CBC
Lytes
Extended lytes (Ca)
VBG

Question 9

Ionotropes:
Warm Shock
Cold Shock

Answer 9

COLD SHOCK

Epinephrine:

Vasoactive med of choice for Infants and Children with fluid refractory hypotensive shock

4 mg epinephrine is mixed with 250 ml of NS

0.01-0.5 mcg/kg/min

Usual 0-0.3 mcg/kg/min

WARM SHOCK

Norepinephrine:
4 mg OR 8 mg in 250 ml saline = 16 ug / ml or 32 ug / ml

0.05 - 0.5 mcg / kg / min