Final answer:
The appropriate fluid bolus for shock resuscitation in a child with a normal heart is typically an isotonic saline or lactated Ringer's solution administered intravenously at 20 mL/kg. This can be repeated based on the child's response. The goal is to correct hypovolemia and improve perfusion, with isotonic fluids being the initial treatment of choice.
Step-by-step explanation:
The Appropriate Fluid Bolus for Shock Resuscitation in Children
When managing shock resuscitation in a child with a normal heart, the standard approach involves the use of intravenous fluids to rapidly expand the circulating volume and improve perfusion. A commonly employed initial bolus is isotonic saline or lactated Ringer's solution, given at a dosage of 20 mL/kg for the first fluid bolus, which can be repeated if the child does not respond to the initial bolus and as long as the child does not have signs of fluid overload. In cases where there is a concern for significant blood loss or if the child weighs less than 10 kg, it is also crucial to consider potential requirements for packed red blood cells; however, isotonic fluids remain the initial treatment of choice to quickly correct hypovolemia.
Correction of dehydration typically involves the administration of isotonic saline, which is closely matched to the body's natural fluid composition. For children who may have lost fluids that are high in sodium and bicarbonate, such as through gastrointestinal losses like severe vomiting or diarrhea leading to hypovolemic shock, a combination of 2/3 isotonic saline and 1/3 sodium lactate can be used. In the management of shock, in addition to fluid replacement, monitoring of vital signs, and urine output, the use of vasopressor medications may also be considered to help maintain blood pressure.