Quote from RNCENCCRNNREMTP
A few blurbs...
Hypovolemic shock is most common shock type in kids
Tachycardia and increased vascular resistance are important early signs, don't miss them.
Hypotension is a LATE sign (after 40% volume lost) don't wait for it.
Prolonged cap refill is only reliable in a warm environment.
Kids with profound dehydration may need 60-100cc/kg IV fluids over the first few hours.
If cardiac arrest occurs there is less than 10% survival rate, prevent it (compared to 75% survive if only resp arrest).
Recovery from arrest is rare (see above) and is often complicated by a cardiogenic shock from depleted O2 and glucose stores. Kids will need epi drips sooner than adults.
A few thoughts off the top of my head this am.
I was recently at a pediatric trauma lecture, they stressed exactly the points you made. It's scary how stable these kids can be and then BOOM they're crashing.
Like I said, in the NICU it's mostly septic shock, but since these kids third space, hypovolemia definitely comes into play before long.
We treat with increased fluids, saline boluses, blood transfusions, dopamine and dobutamine, antibiotics, sodium bicarb, albumin, and high dose IV hydrocortisone. Once in a blue moon we'll have a baby on an epi drip, but 95% of the time it's been started down in the OR during a bloody surgery gone awry.
What do you do in PICU or ER that's different? I'm so curious!