The management of Shock in NYI

Learning objectives

After completion of this session the participant should be able to:

The letter C in “ABCD” stands for Circulation, Coma and Convulsions.
This module will help with the systematic, assessment, resuscitation and treatment of all NYI with life-threatening conditions that are most frequently seen in infants less than 2 months of age


All sick infants are assessed for Airway, Breathing, Circulation, Coma, Convulsions and severe Dehydration (ABCD). In view of the poor outcome in many small infants due to co-existent hypothermia and hypoglycaemia, the management of these is detailed here with ABCD. Efforts should be made to maintain normal blood glucose and a normal body temperature while managing ABCD.

Assess the circulation for signs of shock

After the airway and breathing has been assessed, check circulation: Rapid assessment of circulation

Also important to recognize

Also assess oxygen saturation, heart rate and blood pressure

Is the Capillary Refill Time Longer than 3 Seconds?

Capillary refill is a simple test that assesses how quickly blood returns to the skin after pressure is applied. It is carried out by applying pressure to the centre of the chest over the sternum for 3 seconds. The capillary refill time is the time from release of pressure to complete return of the pink colour. It should be less than 3 seconds. If it is more than 3 seconds the child may be in shock. This sign is reliable except when the room temperature is low, as cold environment can cause a delayed capillary refill. In such a situation check the pulses and decide about shock.

Is the pulse weak and fast?

Evaluation of pulses is critical to the assessment of systemic perfusion. The radial should be felt. If it is strong and not obviously fast (rate greater than 160/min in an infant), the pulse is adequate; no further assessment is needed. In an infant if the radial pulse cannot be felt, palpate for the femoral pulse, if a baby has a weak radial and femoral pulse, it is an ominous sign. Assess hydration status.

Treatment of Shock

Treatment of shock requires teamwork. The following actions need to be started simultaneously.

Giving fluids for shock or impaired circulation