1️⃣ Types of Pediatric Shock (Know These Cold)

• Hypovolemic 🩸: dehydration, hemorrhage
• Distributive 🌡️: sepsis (most common), anaphylaxis, neurogenic
• Cardiogenic ❤️: congenital heart disease, myocarditis
• Obstructive 🚫: tension pneumo, tamponade, PE

2️⃣ Universal Signs of Shock (High Yield)

• Tachycardia (earliest sign)
• Delayed cap refill > 2 sec
• Cool, mottled, pale skin
• Weak or thready pulses
• Altered mental status
• Oliguria / ↓ urine output
• Hypotension = late and pre-arrest

3️⃣ General Management Principles (ALL Shock Types)

A. Immediate Actions 🆘

• Call for help / PALS team
• Airway & breathing: O₂ to maintain SpO₂ > 94%
• Cardiac monitor + large-bore IV/IO access
• Check glucose (treat <70 mg/dL)

B. Fluid Resuscitation ⚡

• 20 mL/kg isotonic fluid bolus (NS or LR)
• Give rapidly over 5–10 min
• Reassess after each bolus
• Can 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 x3
• Control bleeding
• Treat dehydration (fluids + electrolytes)
• Monitor for improvement: HR ↓, cap refill ↑

🌡️ B. Distributive Shock (Septic, Anaphylactic, Neurogenic)

1. Septic Shock

Problem: vasodilation + capillary leak Treatment:

• 20 mL/kg boluses (often large volumes needed)
• Broad-spectrum antibiotics within 1 hour
• Vasopressors if fluid-refractory:
  • Epinephrine or norepinephrine
• Correct glucose & electrolytes
• Warm the child

2. Anaphylactic Shock

Problem: massive vasodilation + airway obstruction Treatment:

• IM Epinephrine 0.01 mg/kg (1:1000) ASAP
• Airway support
• Albuterol neb for wheeze
• IV fluids
• Diphenhydramine + steroids (adjuncts)

3. Neurogenic Shock

Problem: loss of sympathetic tone Treatment:

• Judicious fluids
• Vasopressors (epi or norepi)
• Maintain spinal precautions

❤️ C. Cardiogenic Shock

Problem: ineffective pump DO NOT flood with large fluid boluses.

Management

• Small boluses: 5–10 mL/kg
• Inotropes:
  • Epinephrine
  • Dopamine
  • Milrinone (afterload reduction)
• Correct arrhythmias
• Treat myocarditis / congenital issues
• Consider cardiology consult early