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definitive care is not feasible and there is a provider available experienced in the placement of these devices in children in shock Volume Resuscitation Several studies of pediatric shock have shown decreased mortality with early and aggressive fluid resuscitation, and the current recommendation is to administer fluid in 20-mL/kg boluses pushed over to 10 minutes, with reassessment of perfusion and vital signs, as well as for signs of hepatomegaly and rales, during and after each fluid bolus Fluid boluses totaling up to and over 60 mL/kg should be administered if the child remains in shock, with a goal of delivering at least 60 mL/kg in the first 20 to 60 minutes if shock persists and signs of fluid overload (hepatomegaly, rales) not manifest Ongoing fluid resuscitation should be reconsidered if hepatomegaly or signs of pulmonary edema develop In addition, caution should be taken with rapid fluid resuscitation in neonates 50 kg, a pressure bag or rapid infuser may be used to rapidly administer large volumes of fluid through a large gauge peripheral IV over the goal of minutes The optimal fluid choice for resuscitation remains a matter of debate While Maitland et al showed reduction in mortality in shock related to malaria with albumin versus crystalloid resuscitation and the adult SAFE study showed a trend toward improved survival in subgroup analysis of patients with septic shock receiving albumin versus crystalloid, many other studies have shown no differences in outcome with a colloid versus crystalloid resuscitation strategy Furthermore, the SAFE study showed worse outcomes in the subgroup analysis of patients with traumatic brain injury who received colloid resuscitation Therefore,