Inadequate Perfusion Associated with Hypovolaemia (Paediatric)

Status Evidence of Hypovolaemia     Stop Identify and manage: - Haemorrhage, Fractures, Pain, Tension pneumothorax, Hypoxia

Consider Modifying factors/Assess HR/BP
SCI, Shest injury, Penetrating trunk injury, Uncontrolled haemorrhage
Assess HR (for Tachycardia) and Systolic BP (for Hypotension)
Adequate Perfusion			Inadequate or No Perfusion
Fluid not required			IV access - I/O if unable to obtain
			Normal Saline 20ml/kg IV or I/O
			Assess reponse to Mx
			Adequate Response				No or inadequate improvement
			No further fluids required				Repeat Normal Saline 20ml/kg IV or I/O - If after 40ml/kg Pt remains less than adequately perfused discuss ongoing Mx with RCH or receiving hospital

Special Notes

Modifying factors must be considered and managed prior to aggressive fuid therapy.

Always consider tension pneumothorax, particularly in the Pt with a chest injury, not responding to fuid therapy and persistently hypotensive.

Excessive fuid should not be given if spinal cord injury is an isolated injury.

If IV access is unable to be obtained and the Pt is obtunded, insert I/O.

Pain relief as per Pain Relief

Modifying Factors

Complete spinal cord transection Mx as per Spinal Cord Injury - Pt with isolated neurogenic shock can be given up to 500ml Normal Saline bolus to correct hypotension. No further fluid should be given if SCI is the sole injury.

Chest injury - Consider tension pneumothorax Mx as Chest Injury - Selective (Rural)

Penetrating Trunk Injury, aortic aneurysm or uncontrolled haemorrhage. - Accept palpable carotid pulse and transport immediately