Define Pediatric Shock. Describe its types, stages, clinical features and management.

Definition

• Shock is a state of acute circulatory failure in which oxygen and nutrient delivery is inadequate to meet tissue metabolic demands, leading to cellular dysfunction.
• It is a life-threatening emergency requiring immediate recognition and treatment.

Types of Shock

Stages

• Compensated — blood pressure maintained by tachycardia and vasoconstriction (cool peripheries, prolonged capillary refill); the crucial stage to catch.
• Decompensated (hypotensive) — hypotension is a late sign in children; signals imminent collapse.
• Irreversible — multi-organ failure.

Clinical Features

• Tachycardia, prolonged capillary refill (> 3 s), cool/mottled extremities and weak peripheral pulses.
• Altered sensorium (irritability → lethargy), reduced urine output, tachypnoea.
• Hypotension is a late, ominous finding — do not wait for it to diagnose shock.

Management

• ABC — secure the airway, give high-flow oxygen, obtain IV/intraosseous access quickly.
• Fluid resuscitation — isotonic crystalloid boluses, reassessing after each (cautious, smaller aliquots in cardiogenic shock and severe malnutrition).
• Vasoactive drugs/inotropes (adrenaline/noradrenaline/dopamine) for fluid-refractory shock.
• Treat the cause — early antibiotics for sepsis, blood for haemorrhage, adrenaline for anaphylaxis.
• Correct hypoglycaemia/electrolytes; monitor and admit to intensive care.

Pathophysiology

Reduced oxygen delivery to tissues → Compensation — tachycardia, vasoconstriction (BP maintained) → Anaerobic metabolism → lactic acidosis → Decompensation — hypotension, organ dysfunction

Investigations

• Blood glucose, electrolytes, blood gas/lactate, renal/liver function.
• Blood cultures and CBC/CRP (sepsis); coagulation; imaging as indicated by the cause.

Monitoring

• Heart rate, capillary refill, blood pressure, urine output (aim > 1 mL/kg/h), sensorium, and lactate clearance.
• Frequent reassessment after each intervention.

Warm VS Cold Shock

Goals of Resuscitation

• Restore normal heart rate, capillary refill < 2 s, normal blood pressure and mentation.
• Urine output > 1 mL/kg/h and falling lactate indicate improving perfusion.