# Pediatric shock / hypotension

Reassess after each weight-based fluid bolus and obtain base direction for pediatric push-dose epinephrine.

Population: Pediatric. Scope: ALS.
Status: published. Source-linked OCEMS summary.
Summary updated: 2026-09-16.
Source checked: 2026-09-16.
Source version: See the linked OCEMS source for revision and implementation dates..
Canonical page: https://www.ocmedic.com/guides/pediatric-shock/
Official source: [SO-P-080 — Shock (Symptomatic Hypotension) - Pediatric](https://www.ochealthinfo.com/sites/healthcare/files/2025-05/SO-P-80%20Shock%205-2025.pdf)

Independent OC Medic summary. Does not replace the complete policy, current system notices, or clinical judgment.

## Key cautions & base contact

- Pediatric push-dose epinephrine still requires a base order; the adult PR-230 authorization change does not apply.
- Do not automatically give fluid to a child with cardiogenic shock and pulmonary edema.

## Source documents

- [SO-P-080 — Shock (Symptomatic Hypotension) - Pediatric](https://www.ochealthinfo.com/sites/healthcare/files/2025-05/SO-P-80%20Shock%205-2025.pdf)
- [PR-205 — Preparation and Dosing of Push Dose Epinephrine - Pediatric](https://www.ochealthinfo.com/sites/healthcare/files/2024-10/PR-205%20Peds%20Push%20Dose%20Epi%209-2024.pdf)

## Recognize and monitor

- Assess mental status, pulses, skin signs, BP, respiratory effort, and possible hemorrhage, dehydration, infection, or cardiac disease. Monitor and document the rhythm.
- For room-air SpO₂ below 95%, provide high-flow mask oxygen or nasal cannula/direct blow-by at 6 L/min as tolerated. Use the pediatric bradycardia pathway when indicated.

## Initial resuscitation

- Establish IV; if unresponsive and peripheral IV cannot be obtained, consider IO. Give normal saline 20 mL/kg IV/IO, maximum 250 mL per bolus, and make base contact.
- The order allows two repeats for three total boluses. Reassess BP and perfusion after each bolus. If BP fails to improve after the first bolus, continue indicated fluids and request a base order for pediatric push-dose epinephrine.

## Pediatric push-dose epinephrine

- PR-205 requires base contact and an order before administration. Its dose is 1 mcg/kg IV/IO of the 10 mcg/mL mixture, maximum 10 mcg (1 mL), repeatable every 3 minutes as ordered.
- If cardiogenic shock presents with pulmonary edema, PR-205 directs base contact without giving a fluid bolus. Exclusions include uncorrected hypovolemic shock and suspected stimulant intoxication.

## Glucose & transport

- At glucose 60 mg/dL or less, use oral glucose if tolerated with intact airway reflexes, D10 5 mL/kg IV (maximum 250 mL), or glucagon 0.5 mg IM when IV is unavailable. Respect the source-specific IO dextrose conditions.
- Provide ALS escort and report the suspected cause, weight, cumulative fluids, BP response, glucose, medication dose/concentration, and base orders.