shock is a state of insufficient supply of oxygen for metabolic demand; subclassified into various etiologies including hypovolemic, cardiogenic, septic and distributive and neurogenic shock.

Hypovolaemic shock

• most common cause of shock in children
• Causes: bleeding, burns, GI illnesses, DKA
• Clinical features:
  • Tachycardia/tachypnoea
  • impaired mental status
  • oliguria
  • delayed CRT
  • signs of low volume status - orthostatic hypotension
  • acidosis is common

Cardiogenic shock

• failure of CO
• Causes: arrhythmias, myocarditis, anything which decreases myocardium function. compressive pathologies such as tamponade, PTX
• Clinical features:
  • tachycardia/tachypnoea
  • possible heart murmur
  • possible abnormal rhythm
  • JVP distension
  • hepatomegaly
• Ix: POC USS

Distributive shock

• Causes primarily by inappropriate vascular tone - anaphylaxis = vasodilation, anaesthesia/spinal trauma can decrease sympathetic tone (neurogenic shock) - in the latter 2 there is no reflex tachycardia

Septic shock

• Cold vs warm septic shock
  • ‘Cold shock’ describes a scenario wherein low cardiac output and high SVR results in cool extremities, prolonged capillary refill time and poor peripheral pulses; this is the more common presentation.
  • In ‘warm shock,’ a scenario of high cardiac output and low SVR results in warm extremities, ‘flash’ capillary refill and ‘bounding pulses.’
• In both types - issue is inadewuate tissue perfusion for metabolic demands and tachycardia is prominant

Management