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Compensated shock in children — DIPIMC MCQ

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EasyPaediatric and Obstetric EmergenciesCompensated shock in childrenDIPIMCDipIMC

A 2-year-old with several days of diarrhoea and vomiting is lethargic. The heart rate is 165, central capillary refill is 4 seconds, and the peripheries are cool, but the blood pressure is still within the normal range for age. How should this be interpreted?

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Correct answer: A — Compensated shock with maintained blood pressure

Children compensate for shock by increasing heart rate and vasoconstricting, maintaining a normal blood pressure until a late stage, so tachycardia, prolonged central capillary refill and cool peripheries indicate compensated shock despite a normal pressure. Reassurance based on a normal blood pressure is dangerously misleading. Hypotension in a child is a pre-terminal sign. Pearl: act on the early signs of poor perfusion rather than waiting for the blood pressure to fall.

Reference: APLS; JRCALC Clinical Guidelines