Pediatric Shock Treatment Tool - Evidence-Based Clinical Guide
Evidence-Based Clinical Decision Support | Updated with Phoenix Criteria & Latest Guidelines
Clinical Overview
⚠️ Critical Recognition: Shock is an acute condition where oxygen delivery fails to meet
tissue metabolic demands, leading to organ dysfunction. Early recognition and aggressive treatment
significantly improve outcomes.
Definition & Pathophysiology
Shock: Life-threatening organ dysfunction caused by inadequate tissue perfusion and oxygen delivery.
Key Clinical Markers:
- Altered mental status (lethargy, irritability, decreased consciousness)
- Tachycardia or bradycardia (age-dependent)
- Prolonged capillary refill time (>2 seconds)
- Weak or absent peripheral pulses
- Hypotension (late finding in children)
- Cool extremities / Mottled skin
- Decreased urine output (<1 mL/kg/hr)
- Hyperlactatemia (>2 mmol/L)
2024 Updates NEW
Phoenix Sepsis Criteria (January 2024):
- Replaces SIRS-based criteria from 2005
- Focuses on life-threatening organ dysfunction with infection
- Sepsis diagnosed with ≥2 points on Phoenix Sepsis Score
- Septic shock = sepsis + cardiovascular dysfunction
- Term "severe sepsis" is now redundant
Fluid Resuscitation Updates:
- Tiered approach based on healthcare setting and resources
- Focus on meticulous monitoring for fluid overload
- 10-20 mL/kg boluses over 5-20 minutes (vs previous 20 mL/kg recommendation)
- Early vasopressor consideration after initial fluid
RED Strategy (Resuscitation, Equilibrium, De-escalation):
Phased, personalized hemodynamic approach gaining evidence in 2024
Initial Assessment (ABC Approach)
| Component | Assessment & Action |
|---|---|
| Airway | Assess patency; position; consider adjuncts. Delay intubation if possible until after initial fluid resuscitation (positive pressure ventilation worsens venous return in hypovolemic patients) |
| Breathing | Oxygen saturation, respiratory rate, work of breathing. Provide supplemental O₂ to maintain SpO₂ ≥94% |
| Circulation | Heart rate, blood pressure, capillary refill, pulses, skin temperature/color, mental status. Obtain vascular access immediately |
📍 Key Point: In pediatric shock, hypotension is a late finding. Children
compensate with tachycardia and increased systemic vascular resistance until decompensation occurs. Don't wait
for hypotension to initiate treatment.
Phoenix Sepsis Criteria (2024) NEW
🔍 Purpose: The Phoenix criteria identify children with infection-associated organ
dysfunction at higher risk of mortality. Developed by the Society of Critical Care Medicine using data from >3
million pediatric encounters globally.
Diagnosis Criteria
Sepsis: Suspected or confirmed infection + Phoenix Sepsis Score ≥2 points
Septic Shock: Sepsis + Cardiovascular dysfunction score ≥1 point
Note: The Phoenix Score is NOT a screening tool. Use institutional protocols for early detection of children at risk for sepsis.
Phoenix Sepsis Score Calculator
Respiratory (0-2 points)
Cardiovascular (0-2 points)
Coagulation (0-2 points)
Neurologic (0-2 points)
Age-Specific MAP Thresholds
| Age Group | MAP Threshold (mmHg) |
|---|---|
| <1 month | <31 |
| 1-12 months | <39 |
| 1-2 years | <44 |
| 2-5 years | <45 |
| 5-12 years | <49 |
| 12-18 years | <52 |
Reference: Schlapbach LJ, Watson RS, Sorce LR, et al. International consensus criteria for
pediatric sepsis and septic shock. JAMA. 2024;331(8):665-674.
Types of Pediatric Shock
1. Hypovolemic Shock
Etiology:
Decreased intravascular volume from hemorrhage, dehydration, burns, third-spacing
Clinical Presentation:
- Tachycardia, weak pulses, prolonged capillary refill
- Cool extremities
- History of fluid losses (vomiting, diarrhea, blood loss)
- Sunken fontanelle (infants), dry mucous membranes
Management:
Aggressive fluid resuscitation with isotonic crystalloids (20 mL/kg boluses). Address bleeding source if hemorrhagic. Consider blood products if ongoing hemorrhage.
2. Distributive Shock (Septic, Anaphylactic, Neurogenic)
Septic Shock - Most Common in Children:
Cold Shock (70-80% of pediatric septic shock): Increased SVR, decreased cardiac output. Cool extremities, weak pulses, prolonged capillary refill.
Warm Shock (20-30%): Decreased SVR, high cardiac output initially. Warm extremities, bounding pulses, flash capillary refill.
Management:
- Early broad-spectrum antibiotics (within 1 hour)
- Fluid resuscitation: 10-20 mL/kg boluses
- Cold shock: Epinephrine or dopamine (inotrope + vasopressor)
- Warm shock: Norepinephrine (pure vasopressor)
- Consider hydrocortisone if fluid/vasopressor refractory
Anaphylactic Shock:
First-line: IM epinephrine 0.01 mg/kg (max 0.5 mg). Repeat every 5-15 minutes as needed. Aggressive fluid resuscitation. Antihistamines and corticosteroids as adjuncts.
3. Cardiogenic Shock
Etiology:
Impaired cardiac contractility: myocarditis, cardiomyopathy, congenital heart disease, post-cardiac surgery
Clinical Presentation:
- Signs of heart failure: hepatomegaly, pulmonary edema, JVD
- Gallop rhythm, murmur
- Cool extremities with weak pulses
- Tachypnea, rales
Management:
⚠️ CAUTION with fluids! Limited fluid resuscitation (5-10 mL/kg over 10-20 minutes, carefully monitored). Inotropes (dobutamine, milrinone). Vasodilators if normotensive. Diuretics for volume overload. Early consultation with pediatric cardiology/critical care. Consider ECMO if refractory.
4. Obstructive Shock
Etiology:
Mechanical obstruction to cardiac output: tension pneumothorax, cardiac tamponade, massive pulmonary embolism, ductal-dependent congenital heart disease
Management:
- Tension pneumothorax: Immediate needle decompression → chest tube
- Cardiac tamponade: Pericardiocentesis
- Ductal-dependent lesions: Prostaglandin E1 infusion
- Supportive care with fluids and vasopressors as bridge to definitive treatment
Initial Management Protocol
⏱️ TIME-CRITICAL: First hour management significantly impacts mortality. Early recognition
and aggressive intervention are paramount.
MINUTE 0-5: Recognition & Immediate Actions
- Identify shock state (clinical assessment)
- Call for help / Activate emergency response
- Place on cardiorespiratory monitor
- Supplemental oxygen to maintain SpO₂ ≥94%
- Obtain vascular access (2 large-bore PIVs or IO if unable)
↓
MINUTE 5-15: Initial Resuscitation
- Draw labs: CBC, BMP, blood gas, lactate, blood culture
- Start fluid resuscitation (see Fluid Resuscitation section)
- If septic shock suspected: Obtain cultures → Start broad-spectrum antibiotics within 60 minutes
- Consider point-of-care ultrasound for cardiac function assessment
↓
MINUTE 15-60: Ongoing Resuscitation
- Continue fluid boluses with frequent reassessment
- Monitor for fluid overload (rales, hepatomegaly, decreased SpO₂)
- If fluid-refractory (after 40-60 mL/kg in first hour): Start vasopressor/inotrope
- Consider arterial line for continuous BP monitoring
- Reassess every 5-15 minutes: HR, BP, perfusion, mental status, urine output
↓
BEYOND 60 MINUTES: Advanced Management
- ICU admission / Transport if needed
- Consider central venous access
- Targeted therapy based on shock etiology
- Consider hydrocortisone if vasopressor-dependent septic shock
- Mechanical ventilation if needed (AFTER hemodynamic optimization)
Vascular Access Priorities
| Method | Indication & Considerations |
|---|---|
| Peripheral IV (PIV) | First-line. Two large-bore (18-20G) preferred. Adequate for initial resuscitation including vasopressors (diluted concentration). |
| Intraosseous (IO) | If unable to obtain PIV within 90 seconds or 3 attempts. Proximal tibia or distal femur preferred. All medications and fluids can be given IO. |
| Central Venous Line | NOT required for initial resuscitation. Consider after stabilization for ongoing vasopressor support and monitoring. |
⚠️ Intubation Warning: Avoid early intubation if possible. Positive-pressure ventilation
decreases venous return and can precipitate cardiovascular collapse in hypovolemic patients. Optimize
hemodynamics FIRST, then intubate if needed. Use RSI with etomidate or ketamine (avoid propofol/midazolam in
shock).
Essential Laboratory Studies
| Test | Purpose |
|---|---|
| Blood Gas (VBG or ABG) | Assess acidosis, lactate, base deficit. Lactate >2 mmol/L suggests tissue hypoperfusion. |
| Complete Blood Count | Evaluate for anemia, thrombocytopenia, leukocytosis/leukopenia |
| Basic Metabolic Panel | Glucose, electrolytes, renal function. Monitor for hyperkalemia, hypocalcemia |
| Blood Culture | Before antibiotics if possible, but DO NOT delay antibiotics for cultures |
| Coagulation Studies | PT/INR, PTT, fibrinogen - assess for DIC |
| Type & Screen/Crossmatch | If hemorrhagic shock or significant anemia |
Fluid Resuscitation Protocol
📊 2024 Update: Recent evidence supports smaller, more frequent boluses (10-20 mL/kg) with
meticulous monitoring for fluid overload. The traditional 20 mL/kg bolus is being reconsidered, especially in
resource-limited settings and septic shock.
Fluid Selection
Isotonic Crystalloids (First-line):
| Fluid Type | Indications & Considerations |
|---|---|
| Normal Saline (0.9% NaCl) | Preferred initial fluid. Use for most shock states. Risk of hyperchloremic acidosis with large volumes. |
| Lactated Ringer's | Balanced crystalloid, may reduce hyperchloremia. Avoid in hyperkalemia, severe liver disease. |
| Plasmalyte/Normosol | Balanced crystalloid alternative. No lactate metabolism required. |
Colloids (Limited Role):
Albumin 5%: Consider in refractory septic shock after 40-60 mL/kg crystalloid. No mortality benefit over crystalloids in most cases.
❌ Avoid: Hetastarch and other synthetic colloids (increased mortality and renal dysfunction)
Blood Products:
- Packed RBCs: Hemorrhagic shock or Hgb <7 g/dL in septic shock. Transfuse 10-15 mL/kg.
- Fresh Frozen Plasma: Active bleeding with coagulopathy (INR >1.5). Dose: 10-15 mL/kg.
- Platelets: Active bleeding with platelets <50,000 or <10,000 without bleeding.
Resuscitation Protocol
Initial Bolus:
- Volume: 10-20 mL/kg isotonic crystalloid
- Administration time: Push over 5-20 minutes (faster if profound shock)
- Reassess immediately after each bolus
Fluid Responsiveness Assessment:
Improved perfusion markers:
- Decreased heart rate
- Improved blood pressure
- Improved capillary refill (<2 seconds)
- Warming of extremities
- Improved mental status
- Improved urine output
- Decreasing lactate
Repeat Boluses:
- If fluid-responsive: Continue 10-20 mL/kg boluses
- Reassess after EACH bolus for response AND fluid overload
- Total volumes of 40-60 mL/kg in first hour may be needed
- Some children may require >100 mL/kg in first 24 hours (especially septic shock)
🔴 Fluid Overload Warning Signs:
- New or worsening crackles/rales on lung exam
- Decreasing SpO₂ or increasing oxygen requirement
- Hepatomegaly (liver edge >2 cm below costal margin)
- Jugular venous distension
- Gallop rhythm (S3)
- Worsening respiratory distress
Action: STOP fluid boluses. Consider vasopressor/inotrope support. May need diuretics if severe overload.
Special Populations
Cardiogenic Shock:
⚠️ Restrict fluids! Small boluses: 5-10 mL/kg over 10-20 minutes with careful monitoring. Watch closely for fluid overload. Early inotrope use.
Malnourished Children:
Reduced fluid tolerance. Use 5-10 mL/kg boluses cautiously. High risk of fluid overload and electrolyte disturbances.
Resource-Limited Settings:
Consider more conservative fluid approach (e.g., 20-40 mL/kg maximum in first hour) if limited monitoring and mechanical ventilation availability.
References: Weiss SL, Peters MJ, Alhazzani W, et al. Surviving sepsis campaign international
guidelines for septic shock and sepsis-associated organ dysfunction in children. Intensive Care Med. 2020. |
Davis AL, et al. American College of Critical Care Medicine clinical practice parameters for hemodynamic
support of pediatric and neonatal septic shock. Crit Care Med. 2017.
Vasopressor & Inotrope Therapy
⏱️ Timing: Consider vasopressor/inotrope support if shock persists after 40-60 mL/kg fluid in
first hour, or earlier if signs of fluid overload. Do not delay vasopressors waiting for central access - can
use peripheral/IO initially with diluted concentrations.
Agent Selection by Shock Phenotype
Cold Shock (High SVR, Low Cardiac Output) - Most Common:
First-line: Epinephrine
- Combined inotropic and vasopressor effects
- Increases cardiac contractility and heart rate
- Increases SVR at higher doses
- Preferred agent in pediatric septic shock
Alternative: Dopamine
- Dose-dependent effects (inotropic at mid-range doses)
- May be preferred in some centers, especially with bradycardia
- More arrhythmogenic than epinephrine
Warm Shock (Low SVR, High Cardiac Output):
First-line: Norepinephrine
- Potent vasoconstrictor with minimal inotropic effect
- Increases SVR and blood pressure
- Preferred for distributive shock with low SVR
Refractory Shock:
Add: Vasopressin
- Non-adrenergic vasoconstrictor
- May restore vascular tone in catecholamine-resistant shock
- Low dose: 0.0003-0.002 units/kg/min
Consider: Hydrocortisone
- For fluid and vasopressor-refractory septic shock
- Dose: 50-100 mg/m²/day divided q6h or continuous infusion
- Consider if requiring high-dose vasopressors
Vasopressor & Inotrope Dosing Table
| Agent | Dose Range | Mechanism | Key Points |
|---|---|---|---|
| Epinephrine | 0.05-1 mcg/kg/min | α+β agonist | First-line for cold shock. Increases HR, contractility, SVR. Start 0.05-0.1, titrate up. |
| Norepinephrine | 0.05-1 mcg/kg/min | α++β agonist | First-line for warm shock. Potent vasoconstrictor. Minimal chronotropic effect. |
| Dopamine | 5-20 mcg/kg/min | Dose-dependent | Alternative to epinephrine for cold shock. β effects 5-10 mcg/kg/min, α effects >10. More arrhythmogenic. |
| Dobutamine | 2-20 mcg/kg/min | β1++β2 agonist | Pure inotrope. For cardiogenic shock or low cardiac output with adequate SVR. May decrease BP if SVR low. |
| Vasopressin | 0.0003-0.002 units/kg/min (Max 0.06 units/min) |
V1 receptor | For catecholamine-resistant shock. Non-adrenergic vasoconstrictor. Use LOW doses. |
| Milrinone | Loading: 50 mcg/kg over 10-60 min Infusion: 0.25-0.75 mcg/kg/min |
PDE-3 inhibitor | Inotrope + vasodilator. For cardiogenic shock with high SVR. Risk of hypotension - load carefully. |
Peripheral/IO Administration
Vasopressors can be safely given via peripheral IV or IO in emergencies using diluted concentrations:
- Epinephrine peripheral: 0.05-0.3 mcg/kg/min via PIV safe for hours
- Norepinephrine peripheral: Up to 0.3 mcg/kg/min acceptable short-term
- Dilution strategy: Use more dilute concentrations (e.g., 20 mcg/mL vs 100 mcg/mL) to reduce extravasation injury risk
- Monitoring: Frequent inspection of IV site for infiltration
- Action if extravasation: Stop infusion, elevate extremity, consider phentolamine if extensive
- Transition to central access when feasible for prolonged infusions or high doses
Medication Preparation Quick Reference
Standard Concentration Formula (60 x weight):
Mix [6 x weight in kg] mg in 100 mL → 1 mL/hr = 0.1 mcg/kg/min
Example for 10 kg child:
- Epinephrine: 6 mg in 100 mL D5W
- Starting dose 0.05 mcg/kg/min = 0.5 mL/hr
- Target dose 0.1 mcg/kg/min = 1 mL/hr
Note: Always verify concentrations with pharmacy. Use infusion pumps. Double-check calculations.
💡 Clinical Pearls:
- Don't delay vasopressors waiting for central line - peripheral/IO acceptable initially
- Choose agent based on shock phenotype (cold vs warm)
- Titrate to clinical endpoints: adequate perfusion, normalized lactate, appropriate BP for age
- If one agent not effective at mid-range dose, add second agent rather than pushing first to maximum
- Reassess shock phenotype frequently - can change during resuscitation
Pediatric Shock Management Algorithm
RECOGNITION OF SHOCK
Altered mental status + Tachycardia + Poor perfusion (weak pulses, prolonged CRT, cool/mottled skin) ± Hypotension
↓
IMMEDIATE ACTIONS (0-5 min)
- Call for help / Activate code
- Cardiorespiratory monitor, pulse oximetry
- Oxygen to SpO₂ ≥94%
- Vascular access: 2 large-bore PIVs or IO if unable within 90 sec
- Draw labs: CBC, BMP, blood gas, lactate, cultures
↓
INITIAL FLUID RESUSCITATION (5-15 min)
Give 10-20 mL/kg isotonic crystalloid over 5-20 minutes
If Septic Shock: Obtain cultures → Antibiotics within 60 min
Reassess immediately: HR, BP, perfusion, mental status
↓
DECISION POINT
| ✓ Improved perfusion? Continue fluid boluses as needed Monitor for fluid overload |
✗ Persistent shock after 40-60 mL/kg? OR signs of fluid overload? → START VASOPRESSOR/INOTROPE |
↓
VASOPRESSOR SELECTION
| Cold Shock (cool extremities, weak pulses) |
Warm Shock (warm extremities, bounding pulses) |
|---|---|
| Epinephrine 0.05-0.1 mcg/kg/min OR Dopamine 5-10 mcg/kg/min |
Norepinephrine 0.05-0.1 mcg/kg/min |
Can start via peripheral/IO - diluted concentration
↓
ONGOING MANAGEMENT
- Titrate vasopressor to adequate perfusion and BP
- If inadequate response: Add 2nd agent or consider vasopressin
- Consider hydrocortisone if fluid+vasopressor refractory
- ICU admission / Transport
- Consider central venous access
- Continuous monitoring: BP, perfusion, lactate, urine output
- Treat underlying cause
↓
GOALS OF RESUSCITATION
- Normal mental status
- Normal HR for age
- Capillary refill <2 seconds
- Normal/strong pulses
- Warm extremities
- MAP appropriate for age
- Urine output ≥1 mL/kg/hr
- Lactate normalizing (<2 mmol/L)
- ScvO₂ >70% (if available)
📋 Checklist for Optimal Management:
- ☐ Vascular access obtained within 5 minutes
- ☐ First fluid bolus started within 5-10 minutes of recognition
- ☐ Antibiotics within 60 minutes if septic shock
- ☐ Reassessment after each intervention
- ☐ Vasopressor started if inadequate response to 40-60 mL/kg
- ☐ Continuous monitoring of perfusion parameters
- ☐ ICU consultation/admission arranged
- ☐ Source control addressed (if applicable)
📖 How to Use This Tool
User Guide
Purpose:
This tool provides evidence-based guidance for recognition and management of pediatric shock states. It is designed for emergency physicians, pediatricians, intensivists, residents, and healthcare providers caring for critically ill children.
Navigation:
- Overview: Quick reference for shock definition, recognition, and initial assessment
- Phoenix Criteria: New 2024 sepsis scoring system with interactive calculator
- Shock Types: Detailed breakdown of hypovolemic, distributive, cardiogenic, and obstructive shock
- Initial Management: Time-sensitive protocol for first hour of care
- Fluid Resuscitation: Evidence-based fluid selection and administration protocols
- Vasopressors: Agent selection, dosing, and peripheral administration guidelines
- Algorithm: Step-by-step flowchart for clinical decision-making
Best Practices for Use:
- Before the patient arrives: Review the Overview and Algorithm sections to refresh key principles
- During resuscitation: Use the Algorithm section for real-time guidance
- For medication dosing: Reference the Vasopressor section for specific agents and calculations
- For sepsis scoring: Use the Phoenix calculator to assess organ dysfunction
- For educational purposes: Read through all sections systematically
PROS:
- ✓ Evidence-based: Incorporates latest 2024 Phoenix criteria and recent guidelines
- ✓ Comprehensive: Covers all shock types with specific management strategies
- ✓ Time-oriented: Emphasizes critical time windows for interventions
- ✓ Practical: Includes specific dosing, dilutions, and peripheral administration guidance
- ✓ Interactive: Phoenix score calculator for objective assessment
- ✓ Mobile-friendly: Responsive design for use on tablets and phones
- ✓ Quick reference: Color-coded alerts and tables for rapid information access
- ✓ Updated: Reflects 2024 consensus statements and recent trials
- ✓ Educational: Suitable for teaching residents and medical students
CONS / Limitations:
- ⚠️ Not a substitute for clinical judgment: Individual patient factors may require deviation from guidelines
- ⚠️ Institution-specific protocols: Your facility may have different protocols - always follow local guidelines when they differ
- ⚠️ Requires interpretation: Tool provides guidance but clinical context is critical
- ⚠️ Medication availability: Some medications or resources may not be available in all settings
- ⚠️ Evolving evidence: Guidelines continue to evolve; verify current recommendations periodically
- ⚠️ Weight-based dosing: Requires accurate weight measurement for medication calculations
- ⚠️ Internet dependency: Requires device access during resuscitation
- ⚠️ Not diagnostic: Cannot replace comprehensive clinical evaluation
Important Disclaimers:
- This tool is for educational and clinical reference only
- Always verify medication dosages independently
- Follow institutional protocols when they supersede these guidelines
- Consult pediatric intensivists/specialists when available
- Guidelines represent general principles - individualize care
Tips for Effective Use:
- Bookmark this page on your device for quick access during emergencies
- Practice navigation before actual patient encounters
- Use in simulation training to familiarize team members
- Print Algorithm section for posting in resuscitation areas
- Review updates regularly as guidelines evolve
- Cross-reference with institutional shock protocols
- Use Phoenix calculator prospectively to track patient trajectory
ℹ️ About This Clinical Tool
Complete Tool Information
Overview:
The Pediatric Shock Treatment Tool 2024 is a comprehensive, evidence-based clinical decision support resource designed to assist healthcare providers in the recognition and management of shock states in children. This tool synthesizes the latest guidelines and research to provide practical, actionable guidance during time-critical situations.
Key Features:
- 2024 Phoenix Sepsis Criteria: Interactive calculator implementing the new international consensus criteria for pediatric sepsis and septic shock (published January 2024 in JAMA)
- Comprehensive Shock Coverage: Detailed management strategies for all shock types (hypovolemic, distributive, cardiogenic, obstructive)
- Updated Fluid Protocols: Evidence-based fluid resuscitation guidance reflecting recent trials and 2024 recommendations
- Vasopressor Guidelines: Detailed agent selection, dosing tables, and peripheral administration protocols
- Time-Critical Algorithm: Step-by-step flowchart emphasizing critical time windows
- Clinical Decision Support: Color-coded alerts, warnings, and clinical pearls
- Mobile Optimization: Responsive design for use on any device
Evidence Base:
This tool incorporates guidance from:
- Phoenix Sepsis Criteria (2024): Schlapbach et al., JAMA 2024 - International consensus criteria for pediatric sepsis
- Surviving Sepsis Campaign (2020): International guidelines for septic shock and sepsis-associated organ dysfunction in children
- ACCM Guidelines (2017): American College of Critical Care Medicine clinical practice parameters for hemodynamic support
- PALS Guidelines (2020): Pediatric Advanced Life Support protocols
- Recent Trials: FEAST trial, SPROUT study, and other landmark pediatric shock research
- 2024 Updates: Latest evidence on fluid resuscitation strategies and RED (Resuscitation, Equilibrium, De-escalation) approach
Target Users:
- Emergency Medicine Physicians
- Pediatric Intensivists
- Pediatric Emergency Medicine Specialists
- General Pediatricians
- Emergency Medicine Residents
- Pediatric Residents
- Critical Care Fellows
- Nurse Practitioners and Physician Assistants in pediatric/emergency settings
- Emergency Department and ICU Nursing Staff
- Medical Students in clinical rotations
Clinical Scenarios:
This tool is applicable for:
- Septic shock and severe sepsis
- Hypovolemic shock (dehydration, hemorrhage)
- Distributive shock (anaphylaxis, neurogenic)
- Cardiogenic shock (myocarditis, cardiomyopathy, congenital heart disease)
- Obstructive shock (tension pneumothorax, tamponade)
- Undifferentiated shock requiring initial stabilization
- Transfer preparation for critically ill children
What's New in 2024:
Phoenix Sepsis Criteria:
- Replaces 2005 SIRS-based definitions
- Organ dysfunction-focused approach similar to adult Sepsis-3
- Validated across global populations
- Better discriminates mortality risk than previous criteria
- Simplifies diagnosis: infection + Phoenix Score ≥2
Fluid Resuscitation Updates:
- Emphasis on 10-20 mL/kg boluses (vs previous blanket 20 mL/kg)
- Resource-stratified recommendations
- Increased focus on monitoring for fluid overload
- Earlier consideration of vasopressor support
- RED strategy framework (Resuscitation, Equilibrium, De-escalation)
Design Philosophy:
This tool was designed with several key principles:
- Time-criticality: Emphasizes interventions within critical time windows
- Evidence-based: All recommendations supported by current literature
- Practical utility: Includes specific doses, concentrations, and administration details
- Visual hierarchy: Color-coding to distinguish critical warnings, information, and success criteria
- Progressive disclosure: Information organized by clinical workflow
- Accessibility: Designed for use during high-stress resuscitations
Limitations & Scope:
- Focuses on initial recognition and first-hour management
- Does not cover advanced critical care management
- General principles may need modification for specific patient populations
- Cannot account for all clinical scenarios and variations
- Requires provider expertise in resuscitation and critical care
- Should be used alongside clinical judgment and consultation
Updates & Maintenance:
Guidelines for pediatric shock management continue to evolve. Users should:
- Check for updates to this tool periodically
- Stay current with published guidelines from major societies
- Participate in institutional quality improvement initiatives
- Attend continuing education on pediatric resuscitation
- Follow institutional protocol changes
Educational Applications:
- Teaching Rounds: Use as framework for discussing shock management
- Simulation Training: Reference during mock resuscitations
- Case Discussions: Compare actual cases to guideline recommendations
- Study Resource: Comprehensive review for board preparation
- Protocol Development: Template for institutional protocols
- Quality Improvement: Benchmark for reviewing shock cases
Technical Information:
- Format: HTML5 with embedded CSS and JavaScript
- Compatibility: All modern browsers (Chrome, Firefox, Safari, Edge)
- Requirements: No installation needed, works offline after initial load
- Mobile Support: Responsive design adapts to screen size
- Interactive Elements: Phoenix calculator with real-time scoring
- Print-friendly: Can be printed for reference
Acknowledgments:
This tool synthesizes work from numerous researchers, clinicians, and guideline committees dedicated to improving outcomes in pediatric shock. Special recognition to:
- Society of Critical Care Medicine Phoenix Sepsis Criteria investigators
- Surviving Sepsis Campaign guideline authors
- American College of Critical Care Medicine
- Pediatric Advanced Life Support curriculum developers
- All clinicians and researchers advancing pediatric critical care
Disclaimer:
IMPORTANT: This tool is provided for educational and clinical reference purposes only. It does not constitute medical advice and should not replace clinical judgment, consultation with appropriate specialists, or adherence to institutional protocols. Healthcare providers must independently verify all information and make clinical decisions based on individual patient circumstances. The creators assume no liability for outcomes resulting from use of this tool. Always practice within your scope of training and expertise.
Feedback & Improvement:
Clinical tools benefit from user feedback. Consider providing input on:
- Accuracy of information
- Usability during actual resuscitations
- Missing content or features
- Technical issues
- Suggestions for future updates