In pediatric care of compensated shock during transport, which action is recommended?

• A. Wait for decompensation before starting IV fluids
• B. Administer oral rehydration solution
• C. Establish IV or IO access en route to the hospital
• D. Use a central line

Answer: (C)

Establishing IV or IO access en route to the hospital is essential because in compensated shock the child still maintains blood pressure, but tissues are underperfused. Securing vascular access early allows rapid assessment and timely infusion of isotonic fluids to support circulating volume and perfusion, with the ability to monitor response and adjust treatment en route. Delaying access until decompensation increases the risk of progression to unstable shock, which is harder to treat and associated with worse outcomes. Oral rehydration solution isn’t appropriate when shock is present or during transport, as it cannot provide rapid, reliable volume and may be unsafe if the child cannot swallow or is vomiting. A central line is more invasive and slower to establish; peripheral IV or intraosseous access is typically sufficient and preferred for immediate resuscitation in pediatric patients.