A 3-year-old with vomiting and diarrhoea has heart rate 158/min, capillary refill time 4 seconds with cool extremities, weak peripheral pulses, and blood pressure 96/58 mmHg. How is this hemodynamic state best classified?
- A Decompensated shock, because peripheral pulses are weak
- B Normal hydration, because blood pressure is normal for age
- C Compensated shock, because perfusion markers are abnormal but blood pressure is maintained ✓
- D Cardiogenic shock, because heart rate is high relative to blood pressure
Correct answer: C. Compensated shock, because perfusion markers are abnormal but blood pressure is maintained
Explanation
In children, blood pressure is preserved until roughly 25 to 30 percent of circulating volume is lost, so normotension never excludes shock. Tachycardia with prolonged capillary refill, cool extremities and weak peripheral pulses defines compensated shock, and intervention at this stage prevents progression. Weak peripheral pulses occur early in any distributive or hypovolemic state, so option A is wrong, and the findings are typical of hypovolemia rather than pump failure.
Reference: PALS Provider Manual, American Heart Association, 2020 ed.
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