The best evidence exists for the treatment of septic<unk> in adults. However, the pathophysiology of<unk> appears similar in children, and treatment methodologies have been extrapolated to children. Management may include securing the airway via intubation if necessary to decrease the work of breathing and for guarding against respiratory arrest. Oxygen supplementation, intravenous fluids, passive leg raising (not Trendelenburg position) should be started and blood transfusions added if blood loss is severe. It is important to keep the person warm to avoid hypothermia as well as adequately manage pain and anxiety as these can increase oxygen consumption. Negative impact by<unk> is reversible if it's recognized and treated early in time. Fluids Aggressive intravenous fluids are recommended in most types of<unk> (e.g. 1–2 liter normal saline bolus over 10 minutes or 20 ml/kg in a child) which is usually instituted as the person is being further evaluated. Colloids and crystalloids appear to be similar with respect to outcomes., Balanced crystalloids and normal saline also appear to be similar in critically ill patients. If the person remains in<unk> after initial resuscitation, packed red blood cells should be administered to keep the hemoglobin greater than 100 g/l. For those with hemorrhagic<unk>  the current evidence supports limiting the use of fluids for penetrating thorax and abdominal injuries allowing mild hypotension to persist (known as permissive hypotension). Targets include a mean arterial pressure of 60 mmHg, a systolic blood pressure of 70–90 mmHg, or until their adequate mentation and peripheral pulses. Hypertonic fluid may also be an option in this group. Medications Epinephrine auto-injector Vasopressors may be used if blood pressure does not improve with fluids. Common vasopressors used in<unk> include: norepinephrine, phenylephrine, dopamine, dobutamine. There is no evidence of substantial benefit of one vasopressor over another; however, using dopamine leads to an increased risk of arrhythmia when compared with norepinephrine. Vasopressors have not been found to improve outcomes when used for hemorrhagic<unk> from trauma but may be of use in neurogenic<unk>  Activated protein C (Xigris) while once aggressively promoted for the management of septic<unk> has been found not to improve survival and is associated with a number of complications. Activated protein C was withdrawn from the market in 2011, and clinical trials were discontinued. The use of sodium bicarbonate is controversial as it has not been shown to improve outcomes. If used at all it should only be considered if the pH is less than 7.0. People with anaphylactic<unk> are commonly treated with epinephrine. Antihistamines, such as benadryl, diphenhydramine and ranitidine are also commonly administered. Albuterol, normal saline, and steroids are also commonly given. Mechanical support *Intra-aortic balloon pump (IABP) – a device inserted into the aorta that mechanically raises the blood pressure. Use of Intra-aortic balloon pumps is not recommended in cardiogenic<unk>  *Ventricular assist device (VAD) – A mechanical pump that helps pump blood throughout the body. Commonly used in short term cases of refractory primary cardiogenic<unk>  *Artificial heart (TAH) *Extracorporeal membrane oxygenation (ECMO) – an external device that completely replaces the work of the heart. Treatment goals The goal of treatment is to achieve a urine output of greater than 0.5 ml/kg/h, a central venous pressure of 8–12 mmHg and a mean arterial pressure of 65–95 mmHg. In trauma the goal is to stop the bleeding which in many cases requires surgical interventions. A good urine output indicates that the kidneys are getting enough blood flow.
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