The signs of severe shock may be unmistakable, but the signs of early shock can be subtle. Because of the physiological changes related to age the following are guidelines for blood pressure, heart rate and respiratory rate. Upper limits of pulse rate and respiratory rate and lower limits of systolic blood pressure. It is safer, less time requiring than venous cutdown, but should be discontinued once peripheral access has been established. The complications of intraosseous infusion are cellulitis and osteomyelitis.
Hypothermic stress is a significant problem in the child.
The small hypothermic child may be refractory to infusion therapy for shock, and can develop bleeding disorders. Because of their high ratio of body surface area to body mass children can loose the ability to regulate their body temperature All I.V. solutions must be warmed. The baby's extremities should be wrapped with cellophane wrap to decrease convection losses. All fluid for irrigation of the body cavities during surgery must be warm. Remember that tension pneumothorax or haemothorax are not well tolerated by children because of the mobility of the mediastinal structures, and that children sustain bronchial injuries and diaphragmatic lesions more often than adults but injuries of the great vessels have a lower incidence.