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Distributive Shock in PALS: What You Need to Know for Your AHA PALS Class

distributive shock in pals

Distributive shock is a type of shock that occurs when there is a severe loss of blood flow due to the dilation of blood vessels. In pediatric patients, distributive shock can be caused by a variety of factors, including sepsis, anaphylaxis, and/or spinal cord injuries. When treating distributive shock in pediatric patients, the AHA PALS course provides a structured approach to assessment, treatment, and monitoring.

Key Points you must know for your AHA PALS class:

  • Make sure you know the 3 different categories of distributive shock
  • Make sure you know the signs and symptoms for each category of distributive shock
  • Make sure you know the treatment for each category of distributive shock


The first step in managing distributive shock in pediatric patients is to assess the severity of the condition. The PALS guidelines recommend using the pediatric assessment triangle (PAT) to quickly assess the patient’s appearance, work of breathing, and circulation to determine the severity of the shock. Remember that early detection of septic shock is critical!

Distributive shock can be broken down into three (3) categories: septic shock, anaphylactic shock, and neurogenic shock. See below for a list of possible signs and symptoms for each type:


Septic Shock

Anaphylactic Shock

Neurogenic Shock



Signs and Symptoms

·       Altered mental status (irritability, lethargy, decreased LOC)

·       Altered heart rate (tachycardia, but bradycardia also possible)

·       Altered temperature (fever or hypothermia)

·       Altered perfusion (delayed capillary refill, very cool or very warm extremities), pale skin, decreased urinary output

·       Respiratory distress (stridor, wheezing, or both)

·       Edema, especially visible in the face, lips, and tongue

·       Tachycardia

·       Urticaria (hives)

·       Anxiety and/or agitation

·       Hypotension with a wide pulse pressure

·       Normal heart rate or bradycardia

·       Hypothermia


Once the severity of the shock has been assessed, the next step is to initiate treatment. In distributive shock, the primary treatment goal is to improve blood flow by increasing systemic vascular resistance. The initial treatment for most types of shock includes supporting the patient’s airway, breathing, and circulation, monitoring their vital signs, and establishing IV or IO access.

See below for a list of possible treatments for each type of distributive shock:







·      Fluids (10-20 mL/kg NS/LR) over 5-10 minutes

·      Early administration of antibiotics

·      Antipyretics

·      IM epinephrine

·      Fluid boluses

·      Albuterol

·      Antihistamines

·      Corticosteroids

·      20 mL/kg of NS/LR bolus, repeat PRN

·      Vasopressors

Note that in patients with cardiovascular compromise, the fluid dose is typically lowered to 10 mL/kg. Every patient should be assessed carefully after each bolus.


After initiating treatment, it is essential to monitor the patient’s response to therapy. The PALS guidelines recommend continuous monitoring of the patient’s vital signs, including blood pressure, heart rate, respiratory rate, and oxygen saturation. In addition, it is crucial to monitor the patient’s urine output and lactate levels to assess the effectiveness of treatment.


Distributive shock can be a life-threatening condition in pediatric patients. The PALS guidelines provide a structured approach to managing distributive shock, including assessment, treatment, and monitoring. Prompt recognition and treatment of distributive shock are essential to prevent further deterioration of the patient’s condition. By following the PALS guidelines, healthcare providers can effectively manage distributive shock in pediatric patients and improve outcomes.

Have questions about our AHA PALS courses? You can find most of the answers on our registration page, but if you don’t see the answer there, feel free to contact us!