In pediatric hemorrhagic shock, theinitial fluid bolus is 20 mL/kgofisotonic crystalloid(e.g.,normal saline or lactated Ringer's). For a 20-kg child, this equals400 mL of 0.9% NS. Albumin and PRBCs are considered after fluid responsiveness is evaluated or if ongoing blood loss is confirmed.
“The initial step in pediatric fluid resuscitation for hemorrhagic or hypovolemic shock is 20 mL/kg isotonic fluid bolus. Normal saline is the preferred initial fluid.”
(Referenced from CCRN Pediatric – Direct Care: Multisystem, Shock Management)
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