This web site is about Adrenal Shock. I printed and lamented it and put it in the diaper bag (bold the important information about the dosages). Give solu-cortef immedicately for high fever, vomiting, and injury!!! Don't wait!! http://www.med.monash.edu.au/paediatrics/resources/shock.html Shock & Sepsis Definition: Shock is a state of circulatory dysfunction in which tissue O2 delivery is less than required. If untreated, multi-organ failure and death result. Aetiology: Can be broadly classified into the following categories: Hypovolaemic Cardiogenic Septic Endocrine Anaphylactic Clinical signs: Clinical signs are for the most part non-specific, and include tachycardia, hypotension - particularly decreased diastolic BP, gallop rhythm, oliguria, and altered consciuosness. Additional signs of specific underlying disorder should be sought. Management: Management is generally supportive. Specific treatment for the underlying disorder is unlikely to beeffective in the short term with the exception of adrenaline in anaphylaxis or hydrocortisone in Addisonian crisis. As specific therapy will lead to dramatic improvement in these patients, it is critical to consider both conditions early in the resuscitation and treat appropriately. Addisonian crisis Addisonian crisis should be suspected in patients with known glucocorticoid deficiencies on replacement therapy may also present if steroid doses are not increased appropriately during intercurrent infections or other stressful events. Hydrocortisone doses are 50 mg IV for infants -toddlers, and 100 - 150 mg IV for older children - adults. Management for all Shocked Patients Otherwise, management is similar for all shocked patients: Establish parenteral access, preferably with 2 IV lines. If IV access cannot be established, an intra-osseous cannula should be placed. (this is where they drill holes in the bones) Provide supplemental O2 . If cardiogenic shock (eg myocarditis, ventricular arrhythmias etc) is excluded, give colloid in 10ml/kg boluses until BP and HR return to acceptable levels. Cardiogenic shock - suggested by cardiomegally, peripheral and pulmonary oedema, low voltages on ECG, AV valvar regurgitation murmers - should be treated primarily with inotropes, with volume resuscitation used cautiously if at all. Further supportive treatment may include intubation and inotropic support : Intubation should be considered for any patient with depressed consciousness (GCS <= 8) secondary to shock. Inotropic support should be considered for any patient unresponsive to colloid challenge of 40 -50 ml/kg in total. Inotrope selection will depend to some extent on aetiology, but dopamine at a starting dose of 5 - 10 ug/kg/min is a reasonable first choice in most situations (15 mg/kg in 50ml D5 or NS at 1 - 2 ml/hour). Antibiotics should be given in all cases of suspected septic shock, however fundamentals such as airway control and circulatory support must be addressed as a higher priority. Ceftriaxone 100mg/kg IV or IM provides good broad spectrum coverage in most situations. Roberta Preston preston@kreative.net