Editorial “ The Rude Unhinging of the Machinery of Life ” Derek

Shock is one of the most common reasons that children are admitted to the pediatric intensive care unit (PICU). Early recognition and reversal of the shock state are essential to improved outcomes. Unfortunately, shock as a distinct disease state is frequently misunderstood and underrecognized. For example, the clinical definition of shock remains controversial, in large part due to vast number of disorders that cause shock in critically ill and injured children. Shock frequently represents the final stage of clinical deterioration in a number of these disorders, so that the initial signs and symptoms of shock are frequently attributed to the underlying cause and not shock per se.