Fluid Resuscitation
Fluid is the most commonly given treatment for shock in children, and one of the easiest to get wrong in either direction. The PALS course teaches a simple discipline: give a measured bolus, then reassess before giving more.
In short
Isotonic crystalloid boluses of 10 to 20 mL/kg, delivered quickly, with reassessment of perfusion and signs of overload after each one. Smaller volumes and more caution in cardiogenic shock.
For hypovolaemic and distributive shock, boluses of 10 to 20 mL/kg of isotonic crystalloid are given rapidly, by push-pull syringe or pressure bag if needed. The dose is by weight — see weight-based dosing.
In cardiogenic shock, smaller boluses of 5 to 10 mL/kg are given more slowly. Children with certain heart or kidney conditions, or severe malnutrition, also need more care.
In haemorrhagic shock, blood products are given alongside or instead of crystalloid, and bleeding control is the priority.
Two routes are ideal. If IV access is not quickly obtained, use IO access.
For the full first-hour sequence, see septic shock in children.
This guide summarises what the PALS course teaches, for education only. It is not a clinical protocol: follow the current American Heart Association guidelines, linked below, and your institution’s paediatric policies.
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10 to 20 mL/kg of isotonic crystalloid, as taught in PALS, with reassessment after each.
Rapidly, using a push-pull technique or pressure bag if needed.
When there are signs of fluid overload, and in cardiogenic shock.
Yes.
Blood products and bleeding control are the priority.
Paediatric emergencies are learned by doing. Safety First Medical Services is an American Heart Association training centre on Al Reem Island, Abu Dhabi, with HeartCode, classroom and on-site PALS and a two-year AHA PALS Provider eCard.
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What we teach follows the awarding body and the UAE health authorities. For the definitive position on a course or licensing question, these are the places to check.
Last reviewed by the training team at Safety First Medical Services, an American Heart Association training centre at Addax Office Tower, Al Reem Island, Abu Dhabi. Call +971 55 761 9841 or email training@safetyfirstmed.ae.