Which is a sign of decompensated shock in children?

• A. No peripheral pulses, hypotension, lethargy, unstable tachycardia/bradycardia, significantly delayed capillary refill
• B. Normal blood pressure with tachycardia
• C. Hyperthermia with irritability
• D. Bradycardia with warm extremities

Answer: (A)

In children, decompensated shock means the body's compensatory mechanisms have failed and perfusion to vital organs is critically compromised. The most telling combination is signs of very poor peripheral perfusion along with altered mental status and unstable heart rate.

When there are no peripheral pulses and hypotension, it shows that the blood pressure and circulation are collapsing rather than being maintained by the body’s compensatory responses. Lethargy reflects cerebral hypoperfusion, a sign the brain isn’t getting enough blood. An unstable heart rate—either tachycardia that can’t be sustained or progression to bradycardia—indicates the heart is no longer able to compensate for the lost volume and poor preload. Significantly delayed capillary refill confirms global hypoperfusion, as the blood is not circulating effectively to the extremities.

In contrast, normal blood pressure with tachycardia suggests compensated shock where the body still maintains perfusion despite early signs of stress. Hyperthermia with irritability can occur with fever but doesn’t define shock decompensation. Bradycardia with warm extremities would be atypical for decompensated shock, where perfusion is failing and the skin tends to be cold and pale due to vasoconstriction.

So the described signs—absent peripheral pulses, hypotension, lethargy, unstable heart rate, and markedly delayed capillary refill—best indicate decompensated shock in a child.