Shock is a physiologic state characterised by a significant, systemic reduction in tissue perfusion, resulting in decreased tissue oxygen delivery. Although the effects of inadequate tissue perfusion are initially reversible, prolonged oxygen deprivation leads to generalised cellular hypoxia and derangement of critical biochemical processes. These abnormalities rapidly become irreversible and result sequentially in cell death, end-organ damage, failure of multiple organ systems, and death. The shock syndrome is characterised by a continuum of physiologic stages and may progress through three stages if not successfully treated, culminating in end-organ damage, irreversible shock, and death. The challenge for the clinician is to recognise children in shock early (before they develop hypotension), when they are more likely to respond favourably to treatment. Although the cause of shock may not be initially apparent, treatment must begin immediately. To assist with this early recognition, a systematic approach to the evaluation of children with evidence of poor perfusion typically identifies features of the history, physical examination, and ancillary studies that suggest the underlying condition. The paediatric assessment triangle (PAT) provides this systematic approach and rapidly provides a quick evaluation of appearance, breathing, and circulation for acutely ill or injured children that should identify conditions that require immediate intervention. To direct rapid and appropriate treatment, Early goal directed therapy was developed to provide an efficient and effective means of immediate intervention. Early goal directed therapy (EGDT) for shock refers to an aggressive systematic approach to resuscitation involving a series of controlled manipulations of physiologic parameters. The goal is to carry out appropriate treatment according to the algorithm within the first hour of presentation to hospital. This protocol has been used with success in the adult population for whom it was originally designed. Evidence of EGDT effectiveness in the paediatric population has grown along with it’s steadily growing implementation.