Recognition of the clinical manifestations, with early intervention, is imperative for optimal treatment of shock (Box 10-2). In the early stages, the child is able to compensate with tachycardia, tachypnea, and vasoconstriction to maintain cardiac output. If the condition cannot be reversed, a decompensated state arises with altered perfusion (delayed capillary refill, weak pulses, cool extremities, and hypotension) and profoundly altered mental status. Progression results in cardiovascular collapse and death. Table 10-4 presents the general appearance of a child in shock.