Recognition of shock in children: Review

Abstract

Shock, is one of the major problems encountered in pediatric emergency practice. Sometimes the recognition of shock by clinicians may be missed, because it is not commonly seen and can be confused with other more common conditions. Time is very precious in shock, early diagnosis and early goal-directed therapy in shock, significantly reduce mortality and morbidity. Shock should be considered first in a patient with tachycardia, tachypnea, peripheral perfusion failure, hypotension, hypothermia or hyperthermia, altered mental status, decreasing in urine flow, metabolic acidosis and increasing in blood lactate levels. In shock, several neurohumoral compensatory mechanisms go into operation to keep blood pressure at normal levels. If appropriate treatment is not performed and compensatory mechanisms are inadequate, the shock progresses to decompensated stage. After this stage if response to the treatment is not obtained, severe tissue damage occurs. In decompensated stage, response to conventional treatments is not often obtained and fatal multiple organ failure occurs eventually. Shock can be basically classified as hypovolemic, cardiogenic and distributive. In addition there are various of shock types such as septic, toxic and obstructive. In patients with shock, understanding of life-threatening conditions, classification of shock, causes of circulatory failure and shock is required. For this purpose, pediatric assessment triangle can provide quick and easy evaluation of children with life-threatening condition. As knowledges and awareness about shock are increased, it will be easier for clinicians to recognize shock. Thus, the aim of this review is to facilitate recognition of shock by increasing knowledges and awareness about shock.