Specific Management: Shock

Sepsis, trauma, anaphylaxis, hypovolaemia and heart failure may present with shock and reduced level of consciousness.

The first four diagnoses – sepsis, trauma, anaphylaxis and hypovolaemia – can be made relatively easily with careful clinical examination and history taking.

New-onset heart failure can be missed in the ED. It is worth spending time listening properly to the heart sounds as a gallop rhythm can be heard even at relatively fast heart rates.

For shock, fluid boluses are guided by clinical response, up to 60 ml/kg may be required. If more than 40 ml/kg is given, inotropic or vasopressor treatments should be considered, the child should be monitored on a critical care unit and intubation and ventilation considered.

The appropriate specialists should be involved.