Shock

Shock is defined as an abnormality of the circulatory system that results in inadequate organ perfusion and tissue oxygenation. There are many causes:

Hypovolaemic e.g. haemorrhage, gastroenteritis, burns

• Distributive e.g. septicaemia, anaphylaxis
• Cardiogenic e.g. heart failure, cardiomyopathy
• Obstructive e.g. tension pneumothorax, cardiac tamponade
• Dissociative e.g. profound anaemia

Shock is an emergency which needs to be identified and treated urgently.

Important points in history

• History of trauma or burns
• Profuse diarrhoea and vomiting
• Inability to drink
• Abdominal pain
• Fever
• Ingestion of drug or food
• Known cardiac condition
• Pallor

Important points in examination

A child is in shock if s/he has all three of:

• Cold hands
• Capillary refill time >3 seconds
• Fast weak pulse
• Bleeding
• Burns
• Fever
• Urticaria, oral swelling, wheeze
• Hepatomegaly, oedema, fine crackles, cardiac murmur, muffled heart sounds
• Respiratory distress, tracheal deviation, distended neck veins, reduced air entry
• Pallor
• Petechiae

Management

• Ensure adequate Airway and Breathing
• Give Oxygen
• If bleeding apply pressure
• Keep warm
• Establish IV or IO access
• Check for evidence of severe malnutrition

Shock in Malnutrition

Further Treatment of the underlying cause of shock

All children in shock or treated for shock should be initially admitted to an HDU.

NB: Formula to calculate fluids in burns

• Initial 24 hours:
• Ringer’s lactate - normale maintenance fluids plus 1 ml/kg x % burn
• Next 24 hours:
• Normale maintenance fluids (Ringers lactate plus 5 % dextrose)
• Discontinue drip after 48 hourse if well resuscitated
• Contact burns unit if in any doubt
• Measure urine output for 48 hours
• Admit to burns unit once stabilized