Shock in childhood-many causes and difficult to recognize Definition and characteristics in childhood

The severity and temporal course of shock are often underestimated in childhood. It represents a threatening situation in which the oxygen needs of important organs cannot be covered due to the circulatory collapse. In cases of inadequate or delayed initiation of treatment it is associated with a high mortality, especially in children; this can result in secondary organ damage up to multiorgan failure. The lengthened capillary refill time (CRT) is a very specific and early sign of centralization, whereas the blood pressure values in childhood can remain normal for a long time despite severe shock through an increase of the peripheral resistance. Shock is classified into hypovolemic, distributive, cardiogenic and obstructive shock, according to the underlying mechanism. It has to be treated promptly whereby the individual forms of shock each need a differentiated treatment. When the etiology is unclear the initial treatment measures are fluid resuscitation and administration of catecholamine.