Shock is
challenging to diagnose in children even though it is one of the easiest things
to treat. Children have different symptoms of shock than an adult would have
and they pose much harder investigational challenges. It is harder to tell in a
child what’s wrong with them when they are brought in to the emergency room.
You need to know whether they are crying because they are severely injured, in
pain, or are suffering from anxiety. In order to expedite treating them you
will need to learn how to differentiate between them quickly.
A
symptom of shock in children and infants is tachycardia, but it is not a good
general assumption that tachycardia equals shock. Tachycardia can also occur
because the child cannot breathe, a lack of circulation somewhere, or because
the child is experiencing anxiety from being around so many strange people. To
find out what is wrong, the ABC’s (airway, breathing, circulation) should be
addressed first. Look for signs the cardiovascular system isn’t working
properly. Sometimes this can be difficult since children have very strong
cardiovascular systems. This can cause problems since a child can have normal
blood pressure, but still be going into shock. Sometimes shock won’t be
diagnosed until a child is hypotensive and in need of resuscitation. Luckily
children can survive this and recover fully.
A
good recommendation for children in shock is to start administering oxygen
immediately regardless of what their oximeter reading is. If a child has a
Glasgow coma scale of that is less than 8, is hypoxic, or cannot maintain
patency then you should first secure the airway. Intubating in a child has much
different difficulties than if it were an adult. A child is anatomically
different from an adult and they have much smaller mouths with leads to much less
space for the equipment. Infants are inclined towards becoming bradycardic
during intubation. There are other options for those who are comfortable
intubating an infant. You can hand ventilate until a pediatric specialist can
come intubate them. An LMA which is an artificial airway can be used or an anesthiologist
can be called in.
The
rapid restoration of blood is also crucially important. Unfortunately IV access
in children is exceedingly hard due to subcutaneous fat and small veins.
Luckily there are other options such as intraosseous infusion which is a
temporary measure when IV access is impossible. IV access should be obtained
quickly. If you are struggling than should insert an intraosseous needle into a
long bone like the tibia or the femur. Instead of focusing on putting in an IV,
it is more important to get vascular access quickly. Intraosseous infusion has
experienced a resurgence since it was first used in the 1930s, especially in
pediatric resuscitation. The marrow within the bone is effective in the rapid
infusion of drugs and fluids due to the venous circulation in and around it.
Intraosseous access can be established in a minute or less when completed by
experienced hands.
Most
important is constant reassessment of the patient. Hemodynamics will tell you
quickly what is going on. In most tachycardic pediatric patients, the heart
rate will come down with good fluid resuscitation. Continued blood loss could
be a problem if the heart rate does not come down. Luckily no matter how
difficult they are to treat, pediatric patients recover much more quickly. If
you can keep control of the injuries and bleeding, you can usually return the
patients back to their former health.
“Helping Severely Injured Children
Make A Full Recovery.” Mayo Clinic.
Mayo Foundation, n.d. Web. 22 January 2014.
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