Undifferentiated shock (peds) - Revision history

Ostermayer at 17:42, 17 January 2026

2026-01-17T17:42:33Z

← Revisión anterior		Revisión del 17:42 17 ene 2026
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	{{~~Peds top~~}} ~~[[undifferentiated shock]].''~~		{{PediatricPage\|undifferentiated shock}}
	==Background==		==Background==
	Important physiologic differences between pediatric and adult patients		Important physiologic differences between pediatric and adult patients

Elcatracho: /* Management */

2021-03-09T21:05:20Z

Management

← Revisión anterior		Revisión del 21:05 9 mar 2021
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	{{Vasopressor table}}		{{Vasopressor table}}

			===Causes of non-response to vasopressors<ref>Anand Swaminathan, "Occult Causes of Non-Response to Vasopressors", REBEL EM blog, July 13, 2017. Available at: https://rebelem.com/occult-causes-of-non-response-to-vasopressors/.</ref>===
			*[[Acidosis]]
			**Dx: Blood gas, BMP
			**Tx: treat underlying cause, consider bicarbonate gtt
			*[[Hypothyroidism]]
			**Dx: Clinical, TSH
			**Tx: [[levothyroxine]]
			*[[Anaphylaxis]]
			**Dx: History
			**Tx: [[Epinephrine]], [[methylene blue]], ECMO
			*[[Adrenal insufficiency]]
			**Dx: Clinical, cortisol level, [[hyperkalemia]] + [[hyponatremia]]
			**Tx: [[Hydrocortisone]] 100-200mg
			*[[Hypocalcemia]]
			**Dx: ionized calcium, [[prolonged QTc]]
			**Tx: [[Calcium chloride]] or [[calcium gluconate]]
			*[[Hemorrhagic shock\|Occult bleeding]]
			**Dx: Clinical (consider [[GI bleed]] and retroperitoneal hematoma)
			**Tx: Transfusion, treat coagulopathy, surgery/IR interventions
			*[[Toxicology (main)\|Toxicologic]]
			**Dx: Clinical (consider [[beta blocker toxicity]], [[calcium channel blocker toxicity]], [[TCA overdose]], etc)
			**Tx: Depends on etiology (glucagon, hyperinsulin euglycemia therapy, sodium bicarbonate, ECMO, etc)
			*2nd cause of shock
			**Dx: Clinical, consider [[RUSH exam]]
			**Tx: Address underlying cause

	==Disposition==		==Disposition==

Elcatracho: /* Management */

2021-03-09T21:04:23Z

Management

← Revisión anterior		Revisión del 21:04 9 mar 2021
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	**[[NS]] 10cc/kg		**[[NS]] 10cc/kg
	**[[Dobutamine]]		**[[Dobutamine]]

			{{Vasopressor table}}

	==Disposition==		==Disposition==

Rossdonaldson1 at 22:40, 1 July 2020

2020-07-01T22:40:56Z

← Revisión anterior		Revisión del 22:40 1 jul 2020
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	{{Peds top}} [[undifferentiated shock]]		{{Peds top}} [[undifferentiated shock]].''
	==Background==		==Background==
	Important physiologic differences between pediatric and adult patients		Important physiologic differences between pediatric and adult patients

Rossdonaldson1: Rossdonaldson1 moved page Pediatric shock to Undifferentiated shock (peds)

2020-07-01T22:40:38Z

Rossdonaldson1 moved page Pediatric shock to Undifferentiated shock (peds)

← Revisión anterior	Revisión del 22:40 1 jul 2020
(Sin diferencias)

Rossdonaldson1 at 23:52, 28 November 2019

2019-11-28T23:52:34Z

← Revisión anterior		Revisión del 23:52 28 nov 2019
Línea 1:		Línea 1:
	{{Peds top}}		{{Peds top}} [[undifferentiated shock]]
	==Background==		==Background==
	Important physiologic differences between pediatric and adult patients		Important physiologic differences between pediatric and adult patients

Rossdonaldson1 at 23:51, 28 November 2019

2019-11-28T23:51:43Z

← Revisión anterior		Revisión del 23:51 28 nov 2019
Línea 1:		Línea 1:
			{{Peds top}}
	==Background==		==Background==
	Important physiologic differences between pediatric and adult patients		Important physiologic differences between pediatric and adult patients

ClaireLewis: /* Management */

2019-08-25T04:11:23Z

Management

← Revisión anterior		Revisión del 04:11 25 ago 2019
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	*Treat [[hypoglycemia (peds)\|hypoglycemia]]		*Treat [[hypoglycemia (peds)\|hypoglycemia]]
	*Treat [[hypocalcemia]], consider giving empiric calcium as inotrope		*Treat [[hypocalcemia]], consider giving empiric calcium as inotrope
			*If suspect ductal-dependant [[congenital heart disease]]:
			**[[PGE1]] 0.1mcg/kg/min IV/IO
			**[[NS]] 10cc/kg
			**[[Dobutamine]]

	==Disposition==		==Disposition==

ClaireLewis at 19:56, 24 August 2019

2019-08-24T19:56:45Z

← Revisión anterior		Revisión del 19:56 24 ago 2019
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	https://www.chop.edu/clinical-pathway/sepsis-emergent-care-clinical-pathway		https://www.chop.edu/clinical-pathway/sepsis-emergent-care-clinical-pathway
	<references/>		<references/>

			[[Category:Pediatrics]] [[Category:Critical Care]]

ClaireLewis at 19:16, 24 August 2019

2019-08-24T19:16:10Z

← Revisión anterior		Revisión del 19:16 24 ago 2019
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	**Bounding peripheral pulses		**Bounding peripheral pulses
	**Brisk cap refill		**Brisk cap refill

			===Shock index===
			*Shock Index Pediatric-Adjusted (SIPA)- see https://www.mdcalc.com/shock-index-pediatric-age-adjusted-sipa
			*Useful in identifying shock in trauma patients

	==Differential Diagnosis==		==Differential Diagnosis==
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	==Evaluation==		==Evaluation==


	==Management==		==Management==
			*Rapid IV access
			**IO if unable to obtain in <1min
	*Aggressive [[IVF]]		*Aggressive [[IVF]]
	**~~remember~~ hypovolemia may be more profound in peds		**Remember hypovolemia may be more profound in peds
	**40-60mL/kg NS or lactated ringers rapid bolus (e.g push-pull)		**40-60mL/kg NS or lactated ringers rapid bolus (e.g push-pull)
	*[[Vasopressors]] if remains hypotensive OR with poor perfusion (e.g. cool, poor cap refill) after volume resuscitation		*[[Vasopressors]] if remains hypotensive OR with poor perfusion (e.g. cool, poor cap refill) after volume resuscitation
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	*Treat underlying condition!		*Treat underlying condition!
	*Treat [[hypoglycemia (peds)\|hypoglycemia]]		*Treat [[hypoglycemia (peds)\|hypoglycemia]]
			*Treat [[hypocalcemia]], consider giving empiric calcium as inotrope

	==Disposition==		==Disposition==
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	==References==		==References==
	https://rebelem.com/approach-to-the-critically-ill-child-shock/		https://rebelem.com/approach-to-the-critically-ill-child-shock/
			https://pedemmorsels.com/epinephrine-for-shock/
			https://www.chop.edu/clinical-pathway/sepsis-emergent-care-clinical-pathway
	<references/>		<references/>