Maine:Prehospital protocol pediatric shock

Perform general assessment

1. Attempt to identify cause of shock (i.e. allergic reaction)
2. O2 and airway management as appropriate
3. Keep child warm and dry
4. Request ALS transport

Consider causes

Follow individual associated protocols

1. Hypovolemic Shock:
   1. Vomiting/diarrhea
   2. GI bleed
2. Cardiogenic Shock:
3. Anaphylaxis
4. Sepsis or Undifferentiated shock

Fluid bolus

1. Assess for pulmonary edema before administration (crackles)
2. Administer 20mL/kg NS bolus over 5-15 minutes and immediately reasses
   1. For cardiogenic shock, administer 10mL/kg NS per bolus
3. If needed repeat bolus 2 times
4. If available and trained perform point of care lactate
5. Notify receiving hospital

If no treatment response

• Contact medical for additional fluid bolus or norepinephrine infusion
• Norepinephrine infusion must be infused by a pump

Norepinephrine

• Concentration: 8mg in 250 mL NS
• Starting Dose: 0.03 mcg/kg/min
• Usual Dose: 0.03 - 0.25 mcg/kg/min. Max dose is 3 mcg/kg/min
• Titration: Goal SBP > 80 mm Hg. 0.03 mcg/kg/min every 3-5 min

Authors

Daniel Ostermayer, Ross Donaldson