A pediatric patient with suspected hemorrhagic shock after trauma should receive an initial isotonic crystalloid bolus of how many mL/kg?

• A. 20 mL/kg
• B. 60 mL/kg
• C. 10 mL/kg
• D. 30 mL/kg

Answer: (A)

In pediatric hemorrhagic shock, begin resuscitation with a moderate isotonic crystalloid bolus to quickly restore intravascular volume while avoiding overloading a child who may have ongoing bleeding. The best first step is twenty milliliters per kilogram. This amount is small enough to improve perfusion without risking fluid overload, and you should reassess after the bolus by checking perfusion signs such as mental status, color, capillary refill, heart rate, and urine output. If perfusion remains inadequate, you may give additional boluses up to a total of sixty milliliters per kilogram before moving toward blood products and hemorrhage-control interventions. Smaller initial amounts may be ineffective, while larger single boluses too early can worsen edema and respiratory stress.