pressure ventilation Positive pressure ventilation will decrease venous return in a patient who is already hypovolemic, which could precipitate cardiovascular collapse It is therefore prudent to have fluid boluses readily available and vasoactive agents started or immediately ready to administer during this transition Source Control While IV access is obtained and fluid resuscitation to reverse shock is undertaken, early consideration of source control to treat the etiology of shock is necessary Hypovolemic Shock Hemorrhagic shock should be treated with a combination of crystalloid and blood product administration, as discussed above For definitive treatment, the source of bleeding must be found and controlled Ultrasound and computed tomography are important modalities for diagnosis of hemorrhagic shock Interventional radiology procedures to find and control sources of bleeding are also becoming increasingly available in children, though early surgical consultation is recommended as part of the primary and secondary surveys Shock related to hypovolemia from etiologies such as gastroenteritis and dehydration should primarily be treated with fluid resuscitation Patients with gastroenteritis are at risk for ongoing fluid losses and may need prolonged replacement of fluid losses until symptoms improve It is important to check electrolytes in this setting as electrolyte abnormalities, especially abnormalities in sodium handling, are common Cardiogenic Shock Children with congenital heart disease, cardiomyopathies, or myocarditis may present with cardiogenic shock Presence of ductal-dependent congenital heart disease should be suspected in the neonate or young infant (typically