Rapid IV access
IO if unable to obtain in <1min
Aggressive IVF
Remember hypovolemia may be more profound in peds
40-60mL/kg NS or lactated ringers rapid bolus (e.g push-pull)
Vasopressors if remains hypotensive OR with poor perfusion (e.g. cool, poor cap refill) after volume resuscitation
Cold shock: epinephrine 0.05mcg/kg/min starting dose
Can be safely given through good peripheral IV 
Warm shock: norepinephrine 0.05mcg/kg/min to start
Empiric antibiotics for sepsis
Neonatal: Ampicillin 50mg/kg q8h + gentamicin 2.5mg/kg q24h + acyclovir
Peds: *Extended-spectrum penicillin (e.g. piperacillin-tazobactam) ± aminoglycoside ± vancomycin OR3rd or 4th generation cephalosporin ± aminoglycoside ± vancomycin OR Carbapenem ± aminoglycoside ± vancomycin
Consider corticosteroids if volume non-responsive
Treat underlying condition!
Treat hypoglycemia
Treat hypocalcemia, consider giving empiric calcium as inotrope
If suspect ductal-dependant congenital heart disease:
PGE1 0.1mcg/kg/min IV/IO
NS 10cc/kg
Dobutamine
IO if unable to obtain in <1min
Remember hypovolemia may be more profound in peds
40-60mL/kg NS or lactated ringers rapid bolus (e.g push-pull)
Cold shock: epinephrine 0.05mcg/kg/min starting dose
Can be safely given through good peripheral IV 
Warm shock: norepinephrine 0.05mcg/kg/min to start
Can be safely given through good peripheral IV 
Neonatal: Ampicillin 50mg/kg q8h + gentamicin 2.5mg/kg q24h + acyclovir
Peds: *Extended-spectrum penicillin (e.g. piperacillin-tazobactam) ± aminoglycoside ± vancomycin OR3rd or 4th generation cephalosporin ± aminoglycoside ± vancomycin OR Carbapenem ± aminoglycoside ± vancomycin
PGE1 0.1mcg/kg/min IV/IO
NS 10cc/kg
Dobutamine
Acidosis
Dx: Blood gas, BMP
Tx: treat underlying cause, consider bicarbonate gtt
Hypothyroidism
Dx: Clinical, TSH
Tx: levothyroxine
Anaphylaxis
Dx: History
Tx: Epinephrine, methylene blue, ECMO
Adrenal insufficiency
Dx: Clinical, cortisol level, hyperkalemia + hyponatremia
Tx: Hydrocortisone 100-200mg
Hypocalcemia
Dx: ionized calcium, prolonged QTc
Tx: Calcium chloride or calcium gluconate
Occult bleeding
Dx: Clinical (consider GI bleed and retroperitoneal hematoma)
Tx: Transfusion, treat coagulopathy, surgery/IR interventions
Toxicologic
Dx: Clinical (consider beta blocker toxicity, calcium channel blocker toxicity, TCA overdose, etc)
Tx: Depends on etiology (glucagon, hyperinsulin euglycemia therapy, sodium bicarbonate, ECMO, etc)
2nd cause of shock
Dx: Clinical, consider RUSH exam
Tx: Address underlying cause
Dx: Blood gas, BMP
Tx: treat underlying cause, consider bicarbonate gtt
Dx: Clinical, TSH
Tx: levothyroxine
Dx: History
Tx: Epinephrine, methylene blue, ECMO
Dx: Clinical, cortisol level, hyperkalemia + hyponatremia
Tx: Hydrocortisone 100-200mg
Dx: ionized calcium, prolonged QTc
Tx: Calcium chloride or calcium gluconate
Dx: Clinical (consider GI bleed and retroperitoneal hematoma)
Tx: Transfusion, treat coagulopathy, surgery/IR interventions
Dx: Clinical (consider beta blocker toxicity, calcium channel blocker toxicity, TCA overdose, etc)
Tx: Depends on etiology (glucagon, hyperinsulin euglycemia therapy, sodium bicarbonate, ECMO, etc)
Dx: Clinical, consider RUSH exam
Tx: Address underlying cause
Undifferentiated shock 
Hypovolemia
Neurogenic shock
More common and more profound in peds
Spinal shock
hemorrhage,
Cardiogenic shock
Hemorrhagic shock