Evaluation, treatment, and transport of pediatric patients with shock.

Early recognition and correct treatment of shock remain the most important keys to preventing the death and disability frequently caused by this condition in children. The pediatrician plays a vital role in this process and in referral of the patient for transport to tertiary care centers, where shock is best managed. The transport environment creates special challenges in initial stabilization and ongoing treatment of shock. Discussion centers on clinical clues to recognition, on simple measures available to increase tissue oxygenation, and on the issues of pretransport and transport treatment. Support of airway and breathing, vascular access, and correct fluid therapy remain the cornerstones of successful treatment.