Hypotension/Shock — Pediatric Algorithm

What glucose test is done first in pediatric hypotension/shock?

Blood glucose analysis procedure.

What monitoring is applied in pediatric hypotension/shock?

Cardiac monitor.

What vascular access is done in pediatric hypotension/shock?

IV/IO procedure.

When is the Pediatric Airway Protocol used in pediatric shock?

If indicated.

When is the Pediatric Diabetic Protocol used in pediatric shock?

If indicated.

When is the appropriate pediatric cardiac protocol used in pediatric shock?

If indicated.

What often suggests the type of shock in a child?

The history, exam, and circumstances.

What shock types are considered when trauma is involved in a child?

Hypovolemic (bleeding), neurogenic (spinal injury), or obstructive (pneumothorax).

When is the Spinal Precautions protocol used in traumatic pediatric shock?

If indicated.

What wound care priority applies in traumatic pediatric shock?

Control hemorrhage.

What fluids are used for traumatic pediatric shock?

Normal saline or lactated ringers.

When is lactated ringers used in pediatric shock?

Only if trauma related.

What is the dose of fluid bolus for traumatic pediatric shock?

20 mL/kg.

How is the fluid bolus administered for traumatic pediatric shock?

IV/IO.

What BP target is maintained with fluids in traumatic pediatric shock?

Above age-based hypotension.

What is the max fluid dose for traumatic pediatric shock?

60 mL/kg.

When is the Chest Decompression Procedure done in traumatic pediatric shock?

If indicated.

When are vasopressors considered in traumatic pediatric shock?

Only after a 60 mL/kg fluid bolus with declining response.

What is the dose of epinephrine 1:100,000 for traumatic pediatric shock?

0.01 mcg/kg.

What is the dose of epinephrine drip for traumatic pediatric shock?

0.1 mcg/kg/min.

When is the epinephrine drip started in traumatic pediatric shock?

After the epinephrine 1:100,000 dose, if needed.

What causes of hypovolemic shock are considered in a non-trauma child?

Dehydration or GI bleed.

What cause of cardiogenic shock is considered in a non-trauma child?

CHF.

What causes of distributive shock are considered in a non-trauma child?

Sepsis or anaphylaxis.

What causes of obstructive shock are considered in a non-trauma child?

PE or tamponade.

What is the dose of normal saline bolus for non-traumatic pediatric shock?

20 mL/kg.

How is the normal saline bolus administered for non-traumatic pediatric shock?

IV/IO.

When is the normal saline bolus repeated in non-traumatic pediatric shock?

As needed to remain above age-based hypotension.

What is the max total normal saline dose for non-traumatic pediatric shock?

60 mL/kg.

What caution applies to fluids in pediatric cardiogenic shock?

Be cautious of excess fluid administration.

What must be considered before fluids in pediatric cardiogenic shock?

The presence of pulmonary edema.

When is norepinephrine used in pediatric cardiogenic shock?

Early.

What is the dose of norepinephrine for pediatric cardiogenic shock?

0.1 mcg/kg/min.

How is norepinephrine administered for pediatric cardiogenic shock?

IV/IO.

What is the max dose of norepinephrine for pediatric cardiogenic shock?

0.5 mcg/kg/min.

How is norepinephrine adjusted in pediatric cardiogenic shock?

Titrated up to max as needed.

When are vasopressors considered in non-traumatic pediatric shock?

Only after a 60 mL/kg fluid bolus with declining response.

What is the dose of epinephrine 1:100,000 for non-traumatic pediatric shock?

0.01 mcg/kg.

What is the dose of epinephrine drip for non-traumatic pediatric shock?

0.1 mcg/kg/min.

When is the epinephrine drip started in non-traumatic pediatric shock?

After the epinephrine 1:100,000 dose, if needed.

What is the final step in pediatric hypotension/shock?

Transport.