LLSA 2020 - Review 9: Emergency Department Management of Pediatric Shock

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Review 9: Emergency Department Management of Pediatric Shock


Suzanne Bentley, MD, MPH, FACEP
Emergency Medicine, NYC Health + Hospitals/Elmhurst, Elmhurst, NY; Associate Professor, Departments of Emergency Medicine and Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY
Lauren Boehm, MD
Department of Pediatrics, New York University, New York, NY

About this Review

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.

  1. Article Citation
  2. Synopsis
  3. Quick Quiz
  4. Discussion
    1. Recognition and Management of Shock in the Pediatric Population
      1. Fluid Resuscitation, Vasoactive Medications, Steroids, Antibiotics, and Intubation
      2. Assessing Resuscitation
  5. Critique
  6. Key Points
  7. Editor’s Note
  8. Quick Quiz Answers
  9. Table
  10. Original Article

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