PALS Core Case Scenarios - Testing Case Scenario 1 Hypovolemic Shock

Sep 23, 2026

Uploaded by Margaret

Testing Case Scenario 1 describes assessment and management of a 5-year-old with a 3-day history of fever and diarrhea who becomes increasingly lethargic, progressing toward compensated hypovolemic shock. The scenario emphasizes early oxygen administration, immediate vascular access with IV isotonic crystalloid boluses (20 mL/kg) and frequent reassessment of cardiorespiratory status, perfusion, and shock signs. Point-of-care glucose is checked promptly, and secondary assessment for reversible causes is deferred until initial shock therapy is underway.

LanguageEnglish

CategoryExam

FormatPDF

Pages55

Reading Time2 h 19 min

AccessFree to download

Scenario overview and learning objectives

Evaluate—initial assessment (Pediatric Assessment Triangle)

Evaluate—primary assessment (Airway, Breathing/Ventilation, Circulation/Perfusion)

Intervene (primary actions)

Evaluate—secondary assessment (reversible causes)

Sample history and physical examination

Identify and intervene (repeat management)

Testing Case Scenario 1 Hypovolemic Shock (Child) Scenario Lead-in Prehospital: You have been dispatched to transport a 5 year old with a 3-day history offever and diarrhea. She has been increasingly lethargic in the last 2 hours. ED: You are asked to assess and manage a 5 year old with a 3-day history offever and diarrhea. She has been increasingly lethargic in the last 2 hours. Efforts for a peripheral intravenous access have been unsuccessful. General inpatient unit: You are called to assess a 5 year old who has been admitted to the ward with a 3-day history of fever and diarrhea. She has been increasingly lethargic in the last hour and has had severe ongoing diarrhea. Her intravenous access is no longer functioning. ICU: You are called to the bedside of a 5 year old who has been admitted to the intensive care unit with a 3-day history of fever and diarrhea. She has been increasingly lethargic in the last 2 hours and has had severe ongoing diarrhea. Her intravenous access is no longer functioning. | Vital Signs | | | --- | --- | | Heart rate Blood pressure Respiratory rate Spo2
Temperature Weight Age | 140/min
86/52 mm Hg 36/min
97% on room air 38.0°C (100.4°F) 21 kg
5 years | Scenario overview and learning objectives Scenario Overview Emphasis in this scenario should be on identification of compensated hypovolemic shock. Priorities include oxygen, immediate establishment of intravenous (IV) access, and administration of fluid bolus of isotonic crystalloid, repeated as needed to treat shock signs. Reassessment of cardiorespiratory status is needed during and after each fluid bolus. Glucose concentration should be checked early in this lethargic child. Scenario-Specific Objectives • Recognizes signs of compensated and hypotensive shock; this case illustrates compensated hypovolemic shock (key indicators include anxiety, tachypnea without abnormal labor, tachycardia, cool and mottled skin, delayed capillary refill, and normotension) • Summarizes signs and symptoms of hypovolemic shock; in this scenario, the child has a 3-day history of diarrhea and fever, signs of shock, and poor skin turgor • Demonstrates correct interventions for hypovolemic shock; the most important interventions in this scenario include oxygen administration, administration of one or more boluses of isotonic crystalloid, and careful reassessment during and after each fluid bolus • Summarizes how to evaluate systemic (end-organ) perfusion; indirect indicators of end-organ perfusion include skin temperature/ color, level of consciousness, and urine output Evaluate—initial assessment (Pediatric Assessment Triangle) Appearance • Anxious, restless Breathing • Fast rate, increased respiratory effort Circulation • Pale, dry, and significant mottling, especially in hands and feet Identify • Immediate intervention needed Intervene • Activate the emergency response system. Emergency medical services requests additional assistance if needed. • Administer 100% oxygen by nonrebreathing face mask. • Apply cardiac monitor. • Apply pulse oximeter. Evaluate—primary assessment (Focused on assessment needed to support airway, oxygenation, ventilation, and perfusion) • Airway: Patent; no audible abnormal airway sounds (no stridor, no audible wheezing) • Breathing/Ventilation: Respiratory rate about 36/min; minimal intercostal retractions; Spo2 97% on room air, increases to 100% with 100% oxygen; lungs clear on auscultation • Circulation/Perfusion: Central pulses fair, peripheral pulses weak; heart rate 140/min; blood pressure 100/80 mm Hg; capillary refill about 4 seconds; cool, mottled hands and feet Remainder of primary assessment performed if airway, ventilation, and perfusion are adequately supported • Disability: Poor skin turgor • Exposure: Temperature 38.0°C (100.4°F); weight 21 kg © 2020 American Heart Association 1 Identify • Compensated shock • Sinus tachycardia Intervene

FAQs

What are the key indicators of compensated versus hypotensive shock in this scenario?

Compensated hypovolemic shock is characterized by anxiety, tachypnea without abnormal labor, tachycardia, cool and mottled skin, delayed capillary refill, and normotension. Hypotensive shock would indicate progression to low blood pressure and worsening perfusion signs.

What initial interventions are prioritized for this 5-year-old?

Activate emergency response, administer 100% oxygen via nonrebreathing mask, apply cardiac monitoring and pulse oximetry, and obtain vascular access with a focus on IV. Give an isotonic crystalloid bolus of 20 mL/kg rapidly and reassess during and immediately after each bolus.

How should end-organ perfusion be evaluated indirectly during management?

Use indirect indicators such as skin temperature and color, level of consciousness, and urine output to judge systemic (end-organ) perfusion and guide ongoing resuscitation.

Sep 23, 2026

Uploaded by Margaret