Pediatric Septic Shock Algorithm

The Pediatric Septic Shock Algorithm is a systematic and standard approach for the assessment and management of Septic Shock in children. It guides the health professionals for the timely diagnosis, intervention, and advanced treatment.

Septic shock is a serious health condition in which children are identified with extremely low blood pressure, which is life-threatening. The signs may not be clear in the early stage, but they can progress and start causing damage quickly. Hence, timely recognition of symptoms, identification of causes, immediate medical intervention and ongoing monitoring, and support are a must for the treatment of pediatric septic shock.

Types of Septic Shock in Children

The Pediatric Shock comes in two different forms, each representing a unique hemodynamic condition of the body. They are as follows:

Warm Shock (Hyperdynamic): Early stage characterized by a rapid heart rate, bounding pulse, vasodilation, warm/flushed skin.

Cold Shock (Hypodynamic): Late stage with the warning signs like poor perfusion, low blood pressure, slow heart rate, needs urgent intervention.

Symptoms of Septic Shock in Children

The key symptoms of septic shock in children are as follows:

1. Altered mental conditions like confusion or lack of alertness
2. Very high fever over 101.5°F (38.61°C) or low temperature below 96.8°F (38.61°C)
3. Irregular heart rhythms like tachycardia or bradycardia
4. Rapid breathing and heartbeat
5. Signs of infections in the skin, like rashes, dryness, or unusual color
6. Frequent or unconscious urinating or sometimes no urine output at all
7. Weakness, nausea, vomiting, or diarrhea
8. Sleepy and irritable

Step-by-Step Guide to PALS Septic Shock Algorithm

Step 1: Assessment and Identification

1. Recognize the warning signs as early as possible, such as fever or hypothermia, tachycardia, tachypnea, altered mental status, delayed capillary refill, or hypotension.

2. Obtain history for possible infection caused by recent illness, surgery, or indwelling devices.

3. Classify shock type as cold shock (poor perfusion, weak pulses, narrow pulse pressure) or warm shock (bounding pulses, wide pulse pressure).

Step 2: Initial Stabilization

Ensure airway, breathing, circulation (ABC).
Provide supplemental oxygen to maintain SpO₂ > 94%.
Establish IV/IO access promptly.
Monitor vital signs continuously (HR, BP, SpO₂, perfusion).
Administer lactated ringers over 0.9% NaCl if metabolic abnormality is suspected.

Step 3: Treatment within the First Hour

1. Fluid resuscitation: Give 20mL/kg isotonic crystalloid boluses over 5–10 minutes and reassess after each dose. Avoid fluid overload, especially with lung findings or suspected cardiogenic shock.

2. Antibiotics: Administer the empiric broad-spectrum antibiotics within the first hour.

Step 4: Ongoing Monitoring of Signs and Response

1. Reassess perfusion: capillary refill, mental status, urine output, pulse quality, and blood pressure.
2. Monitor for complications: fluid overload, pulmonary edema, arrhythmias from vasoactive drugs.
3. Adjust medical treatment: Administer fluids and vasopressors according to the response. If shock persists after 40–60 mL/kg of fluids or signs of fluid overload appear, start vasoactive agents.
• For cold shock, provide epinephrine drugs (adrenaline)
• For warm shock, provide norepinephrine drugs

Step 5: Continued Medical Therapy and Support

1. Admit the child to the ICU if advanced treatment and monitoring are required.
2. Maintain glucose and electrolyte balance.
3. Provide ongoing antibiotics and supportive care.

Learn PALS Septic Shock Treatment Algorithm!

Pediatric Septic Shock is one of the major life-threatening conditions in children. Healthcare professionals specialized in children’s care use the PALS algorithm for the treatment of pediatric sepsis in infants and children. It guides for recognizing the symptoms early, administering appropriate medical intervention, continuous support, and advanced care for the children suffering the shock.

PALS certification includes an algorithm like this for a step-wise treatment approach, which helps effective emergency response and ultimately improves recovery outcomes. You can boost your emergency preparedness in childcare settings by getting AHA PALS certified from CPR VAM in nearby locations. Get hands-on training on lifesaving skills to handle pediatric emergencies confidently.

FAQs Related to Pediatric Septic Shock Algorithm

1. How Do You Recognize Septic Shock in Children?

To recognize septic shock in children, you should watch closely for the early signs and symptoms such as hypothermia or hyperthermia, skin rashes, rapid heart beat, hypotension, either frequent urination or reduced urine output, vomiting and diarrhea for longer period, irritability and altered mental condition.

2. What is the Most Common Cause of Septic Shock?

Septic Shock is the final stage of Sepsis. The most common causes are pneumonia, urinary tract infections, and intra-abdominal infections like appendicitis, although sometimes other infections can cause it.

3. What is the Initial Treatment for Pediatric Septic Shock?

The initial treatment for pediatric septic shock is administering fluid boluses or antibiotics and still if the shock persists, vasoactive agents like adrenaline are used to bring the normal blood pressure.

4. Can You Recover From Septic Shock?

Yes, you can recover from septic shock, some earlier while for others it takes a long time, especially if the long-term effects are left behind. The recovery timeline depends on various factors such as severity of the shock, individual’s health, type of medical treatment and the patient’s response to it.

5. What is the Difference Between Pediatric Sepsis and Septic Shock?

Pediatric Sepsis is a life-threatening inflammation, leading to organ damage caused due to certain infections, especially due to intra-abdominal infections (appendicitis), urinary tract infections or severe respiratory infection (pneumonia). When sepsis progresses to a severe level called Septic Shock. It is the final stage of sepsis where a child suffers severe cardiovascular dysfunction and cellular and metabolic abnormalities. Sepsis particularly shows signs like rapid heart beat and breathing, fatigue, pale skin or confusion, whereas septic shock is characterized by very cold, damp and discolored skin, little or no urine output and altered mental conditions.