How is hemorrhagic shock treated? Compelling evidence exists in adult populations about massive transfusion protocols and balanced ratios of blood products in lieu of crystalloid resuscitation. Although little evidence exists in the pediatric literature, many trauma centers have adapted adult protocols to their pediatric patients. The tenets of these protocols involve minimizing crystalloid fluid and …
How is cardiogenic shock treated? Cardiogenic shock should be treated with afterload reduction coupled with inotropic support. This can be achieved with low-dose epinephrine (0.05-0.3 μg/kg/minute) and the inodilators, milrinone or amrinone. Sources Mtaweh H, Trakas EV, Su E, et al: Advances in monitoring and management of shock. Pediatr Clin North Am 2013;60(3):641-654.
How is hypovolemic shock treated? Treat hypovolemia with volume. Initial therapy is usually with crystalloids. Acceptable crystalloids are lactated Ringer’s solution and normal saline. Give boluses of 20 mL of fluid per kilogram of body weight, each given over 5 to 10 minutes. Initial volume resuscitation can require 40 to 60 mL/kg or more before …
What are the different types of common pressor agents used to manage shock? Dopamine is an endogenous catecholamine that results in increased inotropy (contractility), increased chronotropy (heart rate), and vasodilation at low doses. At higher doses, dopamine results in vasoconstriction. Dopamine is often used first at low doses because it is tolerated well when given peripherally. Dobutamine is …
What is the initial treatment for shock? There is no single treatment for shock: Therapy is aimed at the cause. That being said, most types of shock respond well to fluid therapy, so if the cause cannot be identified, a single bolus of 20 mL/kg of either normal saline or lactated Ringer’s solution may be …
How can neurogenic shock be distinguished from hemorrhagic shock? The patient with hemorrhagic shock has a rapid and possibly irregular pulse, but the patient with neurogenic shock has a slow and regular pulse.
How to make a presumptive diagnosis of cardiogenic shock? Recent studies have demonstrated that emergency physicians using bedside ultrasonography can correctly identify cardiac wall motion abnormalities as well as cardiac index. This technology makes it easy for the emergency physician to identify patients with abnormal cardiac function. Sources Dey I, Sprivulis P: Emergency physicians can …
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