Shock is a life threatening condition characterized by hypotension. If not treated immediately it
leads to death.
Low blood pressure (systolic BP below 80 mmHg) is the key sign of shock
Weak and rapid pulse
Rapid and shallow breathe
Restlessness and altered mental state
Low urine output.
Signs and symptoms of shock in children must be recognized while still in the compensated
state to avoid irreversible deterioration. Therefore, the following are primarily assessed in
Prolonged capillary filling (more than 3 seconds)
Decreased pulse volume (weak thread pulse)
Increased heart rate (>160/minute in infants, > 120 in children)
Decreased level of consciousness (poor eye contact)
Decreased blood pressure and decreased urine output are late signs and while they can
be monitored the above signs are more sensitive in detecting shock before irreversible.
Types of Shock
I. Emergency treatment
Treatment depends on the type of shock. Intravenous fluid therapy is important in the
treatment of all types of shock except for cardiogenic shock. Prompt diagnosis of underlying
cause is essential to ensure optimal treatment.
Maintain open airway
Administer oxygen with face mask and if needed after intubation with assisted
Check for and manage hypoglycemia
II. Fluid replacement (Not for Cardiogenic shock)
A: 0.9% Sodium chloride given as the 1L bolus infusion. Repeat bolus until blood
pressure is improved.
Transfuse blood and plasma expanders (-) in hemorrhagic shock.
A: 0.9% Sodium chloride 20 mol/kg as a slow infusion.
Do not administer IV fluids in case of Cardiogenic shock but maintain IV access
If patient develops respiratory distress, discontinue fluids
Septicemia in children: All children with shock which is not obviously due to trauma or
simple watery diarrhea should receive antibiotic cover for probable septicemia.
B: Ampicillin 20mg/kg/dose 6 hourly for 7-10 days
C: Ceftriaxone, IM, 50–80 mg/kg/dose immediately as a single dose.
Instructions on Mixing Injection with Water
Do not administer fluids containing calcium , e.g. Ringer-lactate, within 48 hours of
Contra-indicated in neonatal jaundice
Annotate dose and route of administration on referral letter.