- Home
- Medical news & Guidelines
- Anesthesiology
- Cardiology and CTVS
- Critical Care
- Dentistry
- Dermatology
- Diabetes and Endocrinology
- ENT
- Gastroenterology
- Medicine
- Nephrology
- Neurology
- Obstretics-Gynaecology
- Oncology
- Ophthalmology
- Orthopaedics
- Pediatrics-Neonatology
- Psychiatry
- Pulmonology
- Radiology
- Surgery
- Urology
- Laboratory Medicine
- Diet
- Nursing
- Paramedical
- Physiotherapy
- Health news
- Fact Check
- Bone Health Fact Check
- Brain Health Fact Check
- Cancer Related Fact Check
- Child Care Fact Check
- Dental and oral health fact check
- Diabetes and metabolic health fact check
- Diet and Nutrition Fact Check
- Eye and ENT Care Fact Check
- Fitness fact check
- Gut health fact check
- Heart health fact check
- Kidney health fact check
- Medical education fact check
- Men's health fact check
- Respiratory fact check
- Skin and hair care fact check
- Vaccine and Immunization fact check
- Women's health fact check
- AYUSH
- State News
- Andaman and Nicobar Islands
- Andhra Pradesh
- Arunachal Pradesh
- Assam
- Bihar
- Chandigarh
- Chattisgarh
- Dadra and Nagar Haveli
- Daman and Diu
- Delhi
- Goa
- Gujarat
- Haryana
- Himachal Pradesh
- Jammu & Kashmir
- Jharkhand
- Karnataka
- Kerala
- Ladakh
- Lakshadweep
- Madhya Pradesh
- Maharashtra
- Manipur
- Meghalaya
- Mizoram
- Nagaland
- Odisha
- Puducherry
- Punjab
- Rajasthan
- Sikkim
- Tamil Nadu
- Telangana
- Tripura
- Uttar Pradesh
- Uttrakhand
- West Bengal
- Medical Education
- Industry
Shock in Office Practice in Children: IAP Guidelines
Shock is one of the most common emergencies encountered in pediatric practice. Shock is definedas the inability of circulation to meet the metabolic demands of the body. Common types of shock are hypovolemic (dehydration/trauma), distributive (septic/anaphylactic), cardiogenic, and obstructive (i.e., pneumothorax and cardiac tamponade) with variable physiological derangements.
TABLE 1: Physiological variables in different types of shock. | |||
Type of shock | Preload | Afterload | Contractility |
Hypovolemic | ¯¯¯ |  |  |
Distributive (septic/anaphylactic) | ¯ | ¯ or normal | ¯ or normal |
Cardiogenic |  |  | ¯¯¯ |
Obstructive | ¯ |  |  |
TABLE 2: Evaluate and identify the stages of shock. | |
Stages | Physical examination findings |
Compensated shock Organ function is maintained | Early signs of shock: Tachycardia, poor pulses, prolonged (>2 seconds) capillary refill time (CRT), cold peripheries (cold shock), reduced urine output, anxious-irritable child, and generally associated with fast breathing but blood pressure (BP) is normal. Some children may have bounding pulses with flushed CRT and warm peripheries (warm shock). This stage is frequently missed in absence of proper evaluation |
Hypotensive shock End-organ dysfunction Microvascular failure | Worsening trend of above clinical features such as tachycardia, CRT >3 second, cold-clammy skin, oliguria-anuria, dull or drowsy, tachypnea with increased work of breathing along with low BP. Hypotension is defined is systolic BP (SBP) <60 mm Hg in term neonates, <70 mm Hg in infants, < (70+ age in years × 2) in 1–10-year old children and <90 in children above 10 years of age. More than 20–25% acute blood loss or fall of 10 mm of SBP from observed level should be considered significant |
Irreversible shock and cardiac arrest End-organ cellular death | Bradypnea-apnea, bradycardia, very prolonged CRT (>6 seconds), anuria, coma, seizures, and low to nonrecordable BP. This stage may soon progress to cardiac arrest |
TABLE 3: Monitor the shock index in the management of septic shock. | |
Shock index | Heart rate (HR)/systolic blood pressure 1.2 for 4–6 years; 1 for 6–12 years; and 0.9 for >12 years For normal healthy adults: 0.5–0.7 |
TABLE 4: Therapeutic endpoints of shock resolution and ongoing care. | |
Therapeutic endpoints of shock | Organ support to continue in pediatric intensive care unit (PICU) |
| þ Mechanical ventilation þ Renal replacement therapy þ Intracranial pressure management þ Blood transfusion þ Nutritional supplementation
þ Speciality consultations þ Discussion with family on goals of care and prognosis |
In office practice: |
|
- Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med. 2017;43(3):304-77.
- Tiwari L, Chaturvedi J, Anand C. Myocardial dysfunction in sepsis. J Pediatr Crit Care. 2018;5:41-9.
- Weiss SL, Peters MJ, Alhazzani W, Agus MSD, Flori HR, Inwald DP, et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Pediatr Crit Care Med. 2020;21(2):e52-e106.
- World Health Organization. Updated guideline: pediatric emergency triage, assessment and treatment. Geneva: World Health Organization; 2016.
The guidelines can be accessed on the official site of IAP: https://iapindia.org/standard-treatment-guidelines/
I have done my Bachelor of pharmacy from United Institute of Pharmacy and currently pursuing pharmaceutical MBA from Jamia hamdard. I worked as an intern at the position of content creator in Medical Dialogue and am highly obliged to the company for giving me this wonderful opportunity.
Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751