<<The 2020 Lifelong Learning And Self-Assessment Study Guide, Table of Contents
This article is a review of the physiology, presentation, and treatment of shock in the pediatric population. It defines the physiology of shock as an inadequate supply of oxygen and energy/adenosine triphosphate (ATP) to meet tissue and cellular demands. It classifies shock as hypovolemic, distributive, cardiogenic, and obstructive, based on the etiology of the imbalance in supply and demand. The article discusses clinical recognition of shock in the pediatric population—tachycardia, tachypnea, decreased urination, and altered mental status—emphasizing that hypotension is a late finding in children, and clinicians should not wait for this sign before intervening. The article briefly discusses the utility of point-of-care ultrasound (POCUS) in the assessment of pediatric shock. Interventions for pediatric shock are discussed, including fluid resuscitation, the use of vasoactive medications, steroids, antibiotics, and respiratory support. The goals of resuscitation noted are to reverse the above-mentioned clinical signs, with brief mention of early goal-directed therapy (EGDT). The article concludes with 2 algorithms: (1) the recognition of signs of shock, clues to diagnosing the type of shock, and unique treatments of each classification, and (2) an approach to treating pediatric shock in general.
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