Shock is a clinical condition that describes the response individuals may experience when their bodily tissue or organs are damaged or when a significant volume of blood is lost. The body’s physiological response to this trauma can lead to organ failure, or in severe cases, even death. 

Children are particularly vulnerable to shock because of their small body size, which limits the amount of reserve blood they have. If the child is acutely ill, the illness can exacerbate the problem, leaving the child with insufficient blood to meet an illness or trauma’s physiological demands.

PALS online certification can help

Recognizing the signs and symptoms of shock is an important skill healthcare and emergency response professionals will learn in a pediatric advanced life support course.

Individuals with PALS certification learn to develop a keen understanding of the causes, types and degrees of shock in children. This understanding allows them to effectively and efficiently respond in an emergency situation.

The four basic types of shock include hypovolemic, distributive, cardiogenic and obstructive shock. Though PALS courses will go into more detail, here is a quick overview of each type of shock:

Hypovolemic shock

Generally resulting from diarrhea, vomiting, poor fluid intake, hemorrhage, heat stroke or burns, hypovolemic shock is a major cause of infant mortality. In fact, the leading cause of shock worldwide is hypovolemia—or loss of blood volume—due to diarrhea.

Abnormally low blood pressure, rapid breathing and or heart rate, cool pale skin, increased urine output, weak peripheral pulses and changes in mental status are all clinical signs of hypovolemic shock.

Distributive shock

Distributive shock occurs when blood volume is not adequately distributed to organs and tissues. This type of shock is most commonly associated with head or spinal injury, as well as sepsis, a severe allergic reaction.

This type of shock may display signs similar to hypovolemic shock. If a child has higher cardiac output and low systemic vascular resistance, you may see additional signs indicative of a "warm shock", including bounding peripheral pulses, low blood pressure (with a narrow pulse), warm, flushed extremities, and brisk capillary refill.

Cardiogenic shock

Cardiogenic shock is characterized by inadequate tissue perfusion, which is due to myocardial dysfunction. Though the dysfunction may be caused by heart disease or an arrhythmia, congenital heart disease is the most common cause of cardiogenic shock in children. 

Signs of cardiogenic shock in children and infants may include those associated with hypovolemic shock. Additional signs, specific to the cardiogenic effects, may also be present.  These signs include hepatomegaly (enlarged liver), cardiac murmurs, increased respiratory effort, gallop and precordial heave and cyanosis (a blue coloration of the skin and mucous membranes caused by lack of oxygen). Cardiomegaly (enlarged heart) may also be seen on a chest x-ray, while an echocardiograph may indicate cardiac hypertrophy (thickening of the heart muscle.

Obstructive shock

Obstructive shock is caused by physical obstructions to blood flow, which in turn are caused by specific congenital heart diseases that may be seen in infants within the first few weeks of life. Cyanosis (a blue coloration of the skin and mucous membranes due to a lack of oxygen) is typically an indicator of these diseases.

Learning effective management of shock in a PALS course

Immediately determining the cause and type of shock is critical to the effective management of shock.  PALS certification offers a standardized approach to shock management, which helps healthcare professionals and emergency responders improve a patient’s chance of survival.

For more information about PALS training, view Health Education Solutions’ online PALS certification or PALS recertification overviews.

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