A Novel Approach to the Shocky Child

  Start with three quick bedside ultrasounds and you might avoid an unnecessary IV push An 11-year-old boy is brought to your emergency department following a few hours of persistent vomiting, irritability and decreasing activity. His mother also reports about two days of fever, decreased appetite and nasal stuffness. On initial evaluation, his vital signs include a heart rate of 128 beats/minute, blood pressure of 82/64 mmHg, respirations of 24 breaths/minute and temperature of 101.50F. Pulse oximetry reveals 98% saturation on room air while capillary refill time is approximately 5 seconds. His activity is reduced and skin mottling is evident. His rate and depth of breathing is, however, only slightly increased and his lungs are clear. It is apparent that your patient is in shock and your staff has already started working on intravenous access. One of your most pediatric-experienced nurses asks whether you want 20 cc/kg of normal saline to be pushed as quickly as possible. At this point, the little voice that speaks to most emergency physicians interjects, “Are you sure this is not cardiogenic shock? Could this be the one?” In a previous issue of Soundings, we discussed the case of a 7-year-old child where a strategic approach to ultrasound assisted in diagnosis and resuscitation subsequent to major blunt trauma. In this issue, we will review a systematized approach to the more common presentation of undifferentiated shock. Your response to the nurse is, appropriate...
Source: EPMonthly.com - Category: Emergency Medicine Authors: Tags: Uncategorized Source Type: news