Causes of shock include
- Severe infection (septic shock)
- Severe dehydration
- Cardiac disease
- Cold hands
- Capillary refill >3 seconds
- Weak fast pulse
- Children with these signs are in shock and need emergency treatment.
- For a child without severe malnutrition:
- Infuse 20ml/kg of normal saline or Ringer’s lactate as rapidly as possible.
- Reassess and give a second dose if there is no improvement. You may need 2 or 3 repeats to restore circulating blood volume
- For a child with severe malnutrition:
- Give 15ml/kg of Ringer’s lactate with 5% dextrose or half normal saline with 5% dextrose and infuse over 1 hour.
- After resuscitation: Admit and look for the cause if not already obvious and treat.
- Hb, WBC, platelets
- Blood sugar
- Urea and electrolytes, creatinine
- Blood sugar
- C&S (blood and body fluids).
- Coagulation screen if needed
Management – General
- Resuscitate with normal saline or dextran 20ml/kg. Repeat if necessary – up to 80ml/kg may be required but watch for heart failure. A CVP line is useful.
- Hourly pulse and BP
- Catheterize and monitor urine output hourly: If less than 1–2ml/kg/hr after adequate fluid replacement give frusemide 1–2mg/kg IV STAT. If urine output does not increase assume renal failure and manage accordingly.
- Oxygen via nasal prongs or catheter.
- Definitive treatment of cause.
Management – Pharmacological
- Start empirically on:
- Crystalline penicillin + gentamicin + metronidazole IV. Oral metronidazole can be started as soon as patient is able to swallow.
- Specific antibiotics depend on source of infection and C&S results.
- Ensure that the facilities and skills for intensive care management are available.