Management of pediatric septic shock in the emergency department

Septic shock is a significant source of morbidity and mortality in children. Adhering to evidence-based guidelines for treatment for children with septic shock can lead to better outcomes. Initiation of treatment should begin promptly after recognition of shock in the emergency department. Elements of best practices include rapid administration of intravenous fluid for resuscitation and antibiotics in the first hour. Fluid resuscitation should be titrated to clinical and biochemical end points. If fluid resuscitation is not sufficient to reverse shock, an ionotrope or vasopressor infusion should be initiated. Steroids should be administered in patents known to be at high risk for adrenal insufficiency. All of these interventions should be achieved in the emergency department, ideally within the first hour after recognition of shock.