Paediatrics: Hypovolaemic shock

Hypovolaemic shock

Shock is characterized by inadequate systemic perfusion. The most com-mon type, hypovolaemic shock, is related to abnormally low circulating blood volume.

Aetiology

The causes of hypovolaemia are:

·Trauma.

·GI bleeding.

·Burns.

·Peritonitis.

·Diarrhoea.

·Diabetic ketoacidosis.

Diagnosis

Perform a rapid clinical examination and direct your initial treatment to-ward the patient’s vital signs.

Initial treatment

Follow a standard protocol

·Airway, Breathing, Circulation, Disability (ABCD).

·Blood: in patients with significant blood loss, transfusion will be required (about 2mL/kg to increase haemoglobin concentration by 1g/dL). (Patient may need O –ve unmatched blood in an emergency). Monitor the response with laboratory testing.

·Fluid: acutely, blood pressure and perfusion need to be restored with crystalloid infusion. IV bolus of normal saline, 20mL/kg, can be given over 15min and repeated if necessary. If more than 60mL/kg is required consider endotracheal intubation and ventilatory support. In the patient who is dehydrated, the water and electrolyte deficit needs to be replaced.

·  Refractory hypotension: intubation and intensive care monitoring and therapy are required.