Shock in children

Shock, a major cause of morbidity andmortality in children, is the the most anxiety-provokingemergency that needs to be addressed urgently andeffectively by the attending paediatrician. It is a statewhere the metabolic demands of the tissue are not met dueto circulatory dysfunction. Unlike adults, hypotension isa very late feature of shock in children. As the child’scondition worsens, the clinical presentation of thedifferent causes of shock become similar, and nullifyany aetiological differences. Regardless of the type ofshock, the final common pathway is inadequate tissueperfusion and oxygen supply to meet cellular demands.Delayed recognition and treatment result in progressionfrom compensated reversible shock to uncompensatedirreversible shock with widespread multiple systemorgan failure to death. This paper reviews thephysiological basis, and pathophysiological classificationof the various types of shock and their respectiveaetiologies. The clinical features of the different typesof shock are described, and current diagnostic andtherapeutic strategies are applied for the most effectiveand appropriate treatment for resuscitating the child inshock. A strong index of suspicion, early recognition,timely intervention and transfer to an intensive care unitare critical for successful outcomes in the managementof paediatric shock.