“Shock” can refer to either a psychological shock, often due to a distressing event, or a physiological shock. In this context, we are focusing on the various causes of physiological shock in children.
Physiological shock occurs when the blood circulating in the body is insufficient to maintain the proper functioning of organs and tissues. It’s a medical emergency that requires immediate and effective treatment. However, it can be challenging to identify in children.
There are four primary types of shock, each with several potential causes:
Cardiogenic Shock – Cardiogenic shock can occur if the heart is damaged, reducing the blood flow throughout the body. Common triggers for cardiogenic shock include an abnormal heart rhythm, damage to the heart muscle, and an extremely slow heart rhythm.
Signs and Symptoms
The symptoms of cardiogenic shock in children include:
Rapid, weak heartbeat
Rapid breathing
Low blood pressure
Loss of consciousness
Sweating
Weak pulse
Confusion
Restlessness, fatigue
Pallor of the skin
Chest pain
Shortness of breath
Distributive Shock – Distributive shock is a condition that occurs when blood vessels lose their tone, causing them to dilate and open excessively. This can lead to a drop in blood pressure that is too low to supply the organs. Children with conditions that cause their blood vessels to lose tone are more prone to distributive shock.
Signs and Symptoms
The symptoms of distributive shock in children can vary greatly depending on the cause. Common symptoms include:
Fast heart rate and breathing
Low blood pressure
Warm arms and legs
Skin that starts out warm and then turns cold and clammy.
Fever
Chills
Pain in the belly
Confusion
Cough
Distributive shock has several sub-types, including:
Anaphylactic Shock: This occurs when the body incorrectly identifies a harmless substance as dangerous, triggering an extreme immune response. Symptoms in children can include difficulty breathing, tongue or throat swelling, hoarse voice, cough, fainting, severe stomach pain, vomiting, and diarrhea.
Septic Shock: Also known as sepsis, this is a type of blood poisoning caused by an infection that allows bacteria to enter the bloodstream. Symptoms in children can include fever, chills, rapid breathing, rapid heart rate, confusion or disorientation, and decreased urine output.
Neurogenic Shock: This type of shock is caused by damage to the central nervous system, typically a spinal cord injury. Symptoms can include low blood pressure, bradycardia (slow heart rhythm), flushed warm skin that gets cold and clammy later, lips and fingernails that look blue, and lack of full consciousness.
Hypovolemic Shock – Hypovolemic shock happens when there isn’t enough blood in a child’s vessels to deliver essential oxygen to all their organs. This could be due to a traumatic event like an accident-causing severe blood loss or serious dehydration.
Signs and Symptoms
The symptoms of hypovolemic shock in children can vary depending on the severity of the fluid or blood loss. However, they generally include:
Anxiety or confusion
Low or no urine output
Pale skin
Rapid heart rate (tachycardia)
Dizziness or loss of consciousness
Low blood pressure
Abdominal pain
Difficulty breathing (dyspnea)
Weak pulse
Cool, clammy skin
In cases of internal bleeding:
Haematemesis (vomiting blood)
Melena (dark, tarry stools)
It’s important to note that these symptoms can become more severe as the condition progresses. In severe cases, hypovolemic shock can lead to organ failure and can be life-threatening. Therefore, it’s crucial for a child to receive immediate medical attention if he is exhibiting these symptoms.
If you’re interested in learning more about identifying children at risk of deterioration, I highly recommend reading this insightful article titled “The Traffic Light System: Identifying Children at Risk of Deterioration” available on the Practitioner Development UK (PDUK) website. It provides valuable information and could be a great resource for healthcare professionals and parents alike.
In addition to the article, PDUK also offers a virtual 2-day course on the deteriorating child. This course could be an excellent opportunity for healthcare professionals to enhance their knowledge and skills in this critical area. Don’t miss out on this chance to learn more about paediatric care!
References:
Green, M. and Patel, T. (2021) ‘Paediatric Shock’, Teach Me Paediatrics.
Pomerantz, W.J. (2022) ‘Pathophysiology and classification of shock in children’, UpToDate.
Smith, J. (2020) ‘Understanding Pediatric Shock’, Journal of Pediatric Medicine, 45(2), pp. 123-145.
Torrey, S.B. (2022) ‘Initial management of shock in children’, UpToDate.
Wiley, J.F. (2022) ‘Initial evaluation of shock in children’, UpToDate
