Teaching initial management of shock in children.
Common errors in managing shock in children are failure to recognize shock, failure to recognize continuing blood loss, and inadequate replacement due to lack of familiarity with the normal blood volume of children. For practical purposes, the normal blood volume of every child is considered to be 40 ml/lb (88 ml/kg). In hypovolemic shock the blood volume is reduced by at least one fourth. For initial management, an intravenous line is established, blood is drawn for cross matching, and 10 ml/lb (22 ml/kg) of Ringer's lactate solution is administered as rapidly as possible. If this bolus, which represents one fourth of the normal blood volume, brings the blood pressure to normal, only maintenance fluid is then administered. If the child remains hypotensive, a second bolus of 10 ml/lb (22 ml/kg) is administered rapidly. Children who require a second bolus of Ringer's lactate solution nearly always need blood transfusion also. Many have occult bleeding, usually in the abdomen. If intra-abdominal bleeding is thought to be possible but not definitely present, paracentesis using an angiocath is performed. If no blood returns, 10 ml/lb (22 ml/kg) of saline is instilled and the return considered significant if more than slightly pink.
D000005:Abdomen; D001803:Blood Transfusion; D001810:Blood Volume; D002404:Catheterization; D002496:Central Venous Pressure; D002648:Child; D006400:Hematocrit; D006470:Hemorrhage / Q000175:diagnosis; D006801:Humans; D007263:Infusions, Parenteral; D011677:Punctures; D012771:Shock, Hemorrhagic / Q000097:blood / Q000175:diagnosis / Q000628:therapy*