3.4.

3 Summary: Shock

Recognise the signs:

SHOCK: All 3 signs
1. Cold extremities
2. Weak OR fast (or slow) pulse
3. CRT > 3sec

Emergency management:
A: Maintain an open airway
B: Provide O2, Monitor SpO2
C: Venous access (IV/IO)
Emergency investigations
Mark the liver size
D: Treat hypoglycaemia
E : Maintain temperature
Ceftriaxone IV 100mg/kg

Treatment and surveillance according to cause:

Hypovolaemic Shock Septic Shock Circulatory impairment

(Severe dehydration) severe dehydration + sepsis
No SAM SAM
Hb < 6 g/dL: Hb < 6 g/dL: Hb < 6 g/dL:
Transfuse PRBC 20mL/kg (or Transfuse PRBC 20mL/kg (or Transfuse PRBC 20mL/kg (or
WB 20mL/kg) over 3h WB 20mL/kg) over 3h WB 20mL/kg) over 3h

Hb ≥ 6 g/dL Hb 6-10g/dL: Hb ≥ 6 g/dL

20mL/kg RL bolus Maintenance fluids D5%RL If possible give oral fluids:
(max 3 bolus) ReSoMal 20mL/kg/h
Then fluid 70mL/kg: Hb >10 g/dL:
<1y: over 5h Slow fluid bolus 10mL/kg over If oral not possible:
>1y: over 2.5h 30 mins (max 3 bolus) D5%RL 1.5-2x maintenance
depending on ongoing
NO ADRENALINE Consider: IV adrenaline
losses for 2h.