Schock im Kindesalter

Abstract

The clinical signs and symptoms of shock in newborns and children are often more subtle compared to adults. Recurring, avoidable factors for optimal outcome include failure of health care workers to recognize shock at the time of presentation. Children are able to compensate a shock state for longer periods than adults resulting in a sudden, sometimes irreversible, cardiopulmonary collapse. Different forms of shock, their therapy, and frequent errors are depicted and illustrated with practical examples. Early recognition of shock in children is crucial for optimal outcome but is not always obvious. Clinical experience, gut feeling, and careful and repeated interpretation of the vital parameters are essential to recognize and effectively treat the various forms of shock.

Balanced Electrolyte Solutions or Normal Saline? Resuscitative Fluid Administration Practice in Swiss Pediatric Acute Care

“…The surveyed initial volume administration for shock is in line with current recommendations, 3 that is, administration of 20 mL/kg of isotonic crystalloid boluses, 3 and smaller volumes (5–10 mL/kg) for cardiogenic shock to avoid deterioration of cardiac failure 14 . Hemorrhagic shock and active bleeding require RBC transfusion not later than after two 20 mL/kg of NS boluses 14 . Subsequent fluid administration should be tailored to the individual with frequent clinical reassessments 3 .…”

“…Even if only half of respondents differentiated in the choice of IV fluid depending on the presence or absence of concomitant SHI, these 50% followed the current opinion by using NS/hypertonic saline for patients at risk for brain edema 13 . The surveyed initial volume administration for shock is in line with current recommendations, 3 that is, administration of 20 mL/kg of isotonic crystalloid boluses, 3 and smaller volumes (5–10 mL/kg) for cardiogenic shock to avoid deterioration of cardiac failure 14 . Hemorrhagic shock and active bleeding require RBC transfusion not later than after two 20 mL/kg of NS boluses 14 .…”

Hämorrhagischer Schock im frühen Kindesalter – Besonderheiten der Kreislaufregulation

“…Die Rekapillarisierungszeit wird zentral nach Druck auf das Sternum über 5 s und peripher an einer auf Herzniveau liegenden Extremität gemessen [19]. In den Guidelines 2015 des European Resuscitation Council wird beim Neugeborenen empfohlen, die Farbe der Schleimhäute zu erheben [31], auch wenn dieser Parameter subjektiv ist und eine geringe Sensitivität aufweist [7].…”