Section of Recommendation Evidence Expected Impact Change Quality/ Operational Strength of Educational Financial on Shock - We recommend that assessment for Low/Strong Educational Pearl – Diagnosis shock begin with a targeted clinical history and physical exam, including Add the high risk acquisition of vital signs. features as a pearl in the include some of the high risk clinical beginning of the features for sepsis (high-risk Pediatric Shock Protocol features of invasive infection such as malignancy, bone marrow (after the introductory or solid organ transplant, asplenia, presence of an paragraph and before indwelling central line/catheter, or any other the page 39 “see “red situation with immune deficiency, compromise, or 21”) suppression) The should read features for “High-risk invasive infection include malignancy, bone marrow or solid organ transplant, asplenia, presence of indwelling central line/catheter, or other situation with immune deficiency, compromise or suppression”. Also add in the normal – Pediatric VS to the Specific “Pediatric Equipment Size” bit We recommend that EMS providers and Low/Strong Place pearl in the system leaders implement decision protocols (will be based support tools to assist in the early high-risk clinical identification and treatment of shock in criteria such as – pediatrics presence of as well as age specific VS abnormalities shock is well “Pediatric established before the appearance of classic signs and symptoms. The earliest signs and symptoms of pediatric shock include delayed capillary refill, alterations in mental status, rising pulse, and increasing respiratory rate. By the time blood pressure drops, circulatory collapse is
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