Normally you try to reverse shock...if you want to drive your critical care docs (like me) crazy, don't even attempt to reverse it and see what sort of response you get from them.
While the wording is odd, put it this way: you give fluid, the blood pressure increase is not enough, you start some medications to help the blood pressure.
If you need it more explicit...
The 2007 Practice Parameters for Hemodynamics in Pediatric Septic Shock indicate that after a total of 60ml/kg of fluid boluses (in the ideal scenario, within the first 15 minutes of arrival to a healthcare facility), your patient still has poor perfusion as identified as having a capillary refill time of more than 3 seconds, then you need to start some medication to improve cardiac output (and thus by extension, blood pressure). In pediatrics, most people will start dopamine, while adult sepsis guidelines recommend starting with norepinephrine. One other point to keep in mind is that hypotension is usually a very late sign of shock, particularly in kids.
No matter what field of medicine you go into, identification of critically ill patients is a key skill set to master. As a pediatric critical care fellow, all I want is for someone to recognize that the child is sick and that as a physician, you need help - so you'll call me. I'm sure my adult critical care colleagues will say the same thing. Giving fluids is almost always the right answer, and even when it's not (myocarditis, congenital heart disease) it's usually not so detrimental that it can't be overcome. Even if you go into Derm or Ophtho, there will always be the possibility that a critically ill patient will show up in your office - septic and sicker than snot, and at that point, they need a doctor. As the studies on early goal directed therapy have shown time and time again, fluid boluses save lives. If you don't grasp this concept from your outside reading, please ask one of your residents or attendings to help you.
