Pediatric Hemorrhagic Shock Management
Initial Volume Replacement
- Administer boluses of 20 mL/kg of isotonic crystalloids (normal saline or Ringer's lactate) in the first hour, with a maximum of 60 mL/kg, to a patient with hemorrhagic shock, as recommended by the American College of Critical Care Medicine 1, 2
- Children commonly require 40-60 mL/kg in the first hour, and up to 200 mL/kg can be administered if there are no signs of overload, according to the American Heart Association 2, 3
- In hemorrhagic shock grade 4, the patient will likely require the upper range of replacement, as stated by the World Journal of Emergency Surgery 4
Calcium Replacement - CRITICAL
- Correct hypoglycemia and hypocalcemia immediately, as both are critical therapeutic endpoints in pediatric shock, as recommended by the American College of Critical Care Medicine 1, 2, 5
- The normal ionized calcium level should be maintained as a therapeutic goal, according to the American College of Critical Care Medicine 1
Control of Bleeding - ABSOLUTE PRIORITY
- Definitive control of the bleeding source is obligatory before continuing with more fluids, as stated by the American College of Surgeons [[@ignore ref]]
- However, the American College of Critical Care Medicine recommends that the source of bleeding should be controlled surgically as quickly as possible 2
Blood Transfusion
- Transfuse red blood cells if hemoglobin is <10 g/dL in a patient with active bleeding, as recommended by the American College of Critical Care Medicine [[@ignore ref]]
Therapeutic Endpoints - Specific Objectives
- Achieve all of these parameters: capillary refill ≤2 seconds, normal pulses, warm extremities, urine output >1 mL/kg/h, normal mental status, and normal blood pressure for age, as recommended by the American College of Critical Care Medicine 1, 2
- Maintain normal concentrations of glucose and ionized calcium, as stated by the American College of Critical Care Medicine 1
Continuous Monitoring
- Monitor oximetry, ECG, intraarterial blood pressure, temperature, urine output, glucose, and calcium levels during resuscitation, as recommended by the American College of Critical Care Medicine 1, 2