Identifying and diagnosing shock in children specifically

Tragically, millions of children die of shock across the world every year. Shock is where the body’s circulatory system has failed in some way, so the metabolic demands of tissues cannot be met. Several different etiologies from hypovolemia to severe infection can bring about shock.

There are a number of different types of shock, and we’ve covered these briefly below. This is just a summary and will be covered in more depth on the course.

Hypovolemic shock

This is by far the most common type of shock seen in young patients under 18. Hypovolemia may be absolute with actual fluid losses (severe dehydration with gastrointestinal losses, renal losses in diabetes mellitus, etc) or frank loss of blood as in hemorrhagic shock. Signs of dehydration will be present, including dry mucous membranes and sunken eyes and fontanels.

Septic shock

Sepsis remains a major cause of death in young children. It sometimes occurs in severe sepsis, where the blood pressure fails and the organs of the body do not receive enough oxygen.

Septic shock is typically due to a bacterial infection, resulting from harmful bacteria getting into the bloodstream via a cut, burn or graze for example.

Distributive Shock

Distributive shock may be the result of anaphylaxis (for example due to an allergic reaction) or spinal shock. The mechanism involved here is not an absolute loss of intravascular volume but pathological and inappropriate vasodilatation, endothelial dysfunction with capillary leak, loss of vascular tone or a mixture of all of them.

Obstructive shock

Obstructive shock is due to a circulatory deficiency where venous blood return to the heart is “obstructed”. This is generally the result of an intrathoracic catastrophe such as cardiac tamponade or tension pneumothorax.

Cardiogenic shock

This type of shock is simply a pump failure. Myocardial failure may be primary as in myocarditis, congenital heart disease or secondary as in myocardial dysfunction due to toxin presence. Early use of echocardiography should be considered.

Diagnosing shock in children

Recognising early shock in children can be difficult, requiring thorough examination and more than a little ‘gut feeling’. Symptoms of all types of shock include irritability, tachycardia, altered mental status, tachypnea, high pitched crying, skin rashes, cold mottled extremities and prolonged capillary refill. Children may also be difficult to rouse, or completely unconscious which will be extremely distressing for the parents or carers.

Shock is incredibly dangerous, requiring urgent medical attention. Can you spot the signs?

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