You should be MOST suspicious for cardiogenic shock in an infant or child if:

You should be MOST suspicious for cardiogenic shock in an infant or child if:

• A. Perfusion decreases following a fluid bolus
• B. Perfusion improves after a fluid bolus
• C. Blood pressure is elevated
• D. Respiratory rate decreases

Answer: (A)

In cardiogenic shock, the heart cannot pump effectively, so increasing the circulating volume with a fluid bolus often does not improve—and can worsen—forward flow. If perfusion decreases after a fluid bolus, it signals that the heart isn’t able to handle the extra preload, leading to reduced systemic perfusion and potentially pulmonary edema. This response helps distinguish cardiogenic shock from other shock types in which fluids usually help by increasing preload and stroke volume. Elevated blood pressure is not typical for cardiogenic shock, which more commonly presents with low or borderline pressure. A decreasing respiratory rate would not fit the usual pattern, since tachypnea is common due to metabolic acidosis and pulmonary congestion. So the clue that perfusion worsens after a fluid bolus is the strongest indicator of cardiogenic shock.

In cardiogenic shock, the heart cannot pump effectively, so increasing the circulating volume with a fluid bolus often does not improve—and can worsen—forward flow. If perfusion decreases after a fluid bolus, it signals that the heart isn’t able to handle the extra preload, leading to reduced systemic perfusion and potentially pulmonary edema. This response helps distinguish cardiogenic shock from other shock types in which fluids usually help by increasing preload and stroke volume.

Elevated blood pressure is not typical for cardiogenic shock, which more commonly presents with low or borderline pressure. A decreasing respiratory rate would not fit the usual pattern, since tachypnea is common due to metabolic acidosis and pulmonary congestion. So the clue that perfusion worsens after a fluid bolus is the strongest indicator of cardiogenic shock.