Pitfalls in the management of shock in children….. The concept story
The clinical signs and symptoms of shock in newborns and children are often more subtle compared to adults. Recurring, avoidable factors for optimal outcome include failure of health care workers to recognize shock at the time of presentation. Children are able to compensate for a shock state for longer periods than adults resulting in a sudden, sometimes irreversible, cardiopulmonary collapse. Different forms of shock, their therapy, and frequent errors are depicted and illustrated with practical examples. Early recognition of shock in children is crucial for the optimal outcome but is not always obvious. Clinical experience, gut feeling, and careful and repeated interpretation of the vital parameters are essential to recognize and effectively treat the various forms of shock.
The management of children with shock is challenging. Some pitfalls include, Failure to recognize nonspecific signs of compensated shock (ie, unexplained tachycardia, abnormal mental status, or poor skin perfusion) could be due to Inadequate monitoring of response to treatment Inappropriate volume for fluid resuscitation (usually too little for children with sepsis or hypovolemic shock, but possibly too much for those with cardiogenic shock also Failure to reconsider possible causes of shock for children who are getting worse or not improving, Failure to recognize and treat obstructive shock