ABSTRACT
Traumatic brain injuries are the most frequent cause of paediatric trauma mortality, and these injuries need to be addressed as soon as possible in the trauma bay. The first step in the management of any paediatric patient with signs of traumatic brain injury, as suggested by the primary assessment, is to ensure adequate cerebral blood perfusion. Different types of shock may be encountered in paediatric trauma, the most frequent being haemorrhagic shock. Haemorrhagic shock is a type of hypovolaemic shock. Hypovolaemic shock can occur without haemorrhage, such as with profuse diarrhoea or vomiting, but, in trauma, the cause of hypovolaemic shock is haemorrhage unless proven otherwise. Other types of shock that are very infrequently seen in paediatric trauma include anaphylactic shock and endocrine shock. Endocrine shock can be seen with hypo-/hyperthyroidism and adrenal insufficiency. In trauma, adrenal insufficiency may be superimposed on haemorrhagic shock in a child with a depleted adrenal axis.
