Goal-Directed Management of Pediatric Shock in the Emergency Department

Early recognition and treatment of pediatric shock, regardless of diagnostic category, saves lives. This article emphasizes the early recognition of tachycardia, prolonged capillary refill, and hypotension at triage, and sets out a time-sensitive 3-step process, which includes establishment of emergency vascular access, goal-directed stepwise administration of fluid therapy, and infusion of epinephrine (in some cases with hydrocortisone) for reversal of shock within the first hour of arriving in the emergency department. Although the process outlined is straightforward, it requires thoughtful administrative preparation. Patients in shock must be recognized at triage and then quickly escorted to the resuscitation room, where a team approach is necessary to successfully attain all clinical goals within 1 hour. These time-sensitive goals include reversal of prolonged capillary refill and hypotension and an improved shock index. The goals and processes outlined in this article can be successfully accomplished in both community and tertiary-hospital emergency department settings with advanced planning and training.