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Archived - Pediatric Advanced Life Support (PALS) 2020 > 1 - Shock > Flashcards

1 - Shock Flashcards

1
Q

What is shock?

A

Inadequate oxygen to meet metabolic/tissue demands

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2
Q

Does shock mean hypotension?

A

No it can be normal, increased, or decreased

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3
Q

What shock is from an inadequate blood volume or oxygen carrying capacity?

A

Hypovolemic Shock

Hemorrhagic Shock

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4
Q

What shock is from inappropriate distribution of blood volume and flow?

A

Distributive Shock

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5
Q

What shock is from impaired cardiac contractility

A

Cardiogenic Shock

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6
Q

What shock is from obstructed blood flow?

A

Obstructive Shock

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7
Q

Main function of the cardiopulmonary system

A

deliver O2 to body tissues and remove metabolic by products of cellular metabolism (CO2)

When O2 is inadequate to meet tissue demand
Cells use anaerobic metabolism - to produce energy

= LACTIC ACID

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8
Q

Oxygen delivery to the tissues is dependent on…

A

Arterial O2 content (oxygen bound to hemoglobin plus dissolved O2)

Cardiac output (volume of blood pumped each minute)

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9
Q

Arteries vs veins

A

Arteries carry O2

Veins carry blood back through the vena cava to be reoxygenated

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10
Q

O2 may be normal despite hypoxemia due to what compensation

A

CO increasing

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11
Q

When hypoxemia is chronic what does hemoglobin concentration due

A

increases - polycythemia

Therefore increasing the O2 carrying capacity of the blood

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12
Q

CO =

A

SV X HR

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13
Q

CO
SV
HR

A

CO - (the volume of blood pumped by the heart in each minute)
SV - The amount of blood pumped by the left V with each contraction
HR - Number of times the ventricles contract per minute

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14
Q

Infants are more dependent on CO or HR?

A

very small SV - dependent on HR

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15
Q

Preload

A

Volume of blood present in the ventricle before contraction

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16
Q

Contractility

A

Strength of contractin

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17
Q

Afterload

A

Resistance against which the ventricle is ejecting

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18
Q

Inadequate preload is the most common cause of

A

hypovolemic shock

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19
Q

Inadequate contractility is the most common cause of

A

Cardiogenic Shock

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20
Q

Increased afterload can cause

A

cardiogenic shock

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21
Q

what is pulse pressrue

A

the distance between systolic and diastolic pressure

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22
Q

If SVR is low (as in sepsis) what happens to the pulse pressure

A

diastolic pressure decreases and pulse pressure widens

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23
Q

Compensated shock.

A

Maintain a systolic pressure

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24
Q

Compensated shock clinical symptoms

A 
tachycardia (vasoconstriction)
decreased UO  (Retaining water)
delayed cap refill (send blood to peripheral)
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25
Q

Pulses in compensated shock

A

Narrow pulse pressure (increase in diastolic)

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26
Q

In most types of shock what is hypotension

A

a late finding

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27
Q

what is hypotension in septic shock?

A

When SVR is decreased due to the mediators of sepsis - hypotension will be an early sign
(brisk cap refill, full pulses)

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28
Q

Hypotensive forumla

A

70 + (Age in years X 2)

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29
Q

How long can it take compensated shock to turn into hypotensive shock

A

Possibly hours

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30
Q

Hypotensive Shock to Cardiac arrest?

A

Possibly mintues

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31
Q

Hypovolemic shock etiology

A

Gastroenteritis, burns, hemorrhage, inadequate fluid intake, body fluid loss, osmotic diuresis

32
Q

Cardiogenic shock etiology

A

CHD, myocarditis, cardimyopathy, arrhythmia

33
Q

Distributive shock etiology

DIS (3)

A

Sepsis
Anaphylaxis
Spinal cord injury

34
Q

Obstructive

A

tension pneumo, cardiac tamponade, PE, constriction of the ductus arteriosus in infants with ductal-dependent CH lesions (coarctation, hypoplastic left ventricle)

35
Q

Hypovolemic shock is typically a depletion of both

A

intravascular and extravascular fluid volume

36
Q

What type of fluid boluses are required for hypovolemic shock

A

Fluid boluses that exceed the volume of the intravascular deficit due to extravascular deficit as well

37
Q

What respiratory compensation is used in hypovolemic shock

A

typically tachypnea - creates respiratory alkalosis - blowing off CO2

Partially compensating for metabolic acidosis (lactic acidosis) that accompanies shock

38
Q

Hypovolemic shock is characterized by a

A

decrease preload leading to reduced SV and low CO

39
Q

Hypovolemic shock main compensatory mechanisms

A

Tachycardia
Inc SVR
Increased cardiac contractility

40
Q

Relative hypovolemia

A

Arterial/Venous vasodilation
Increased capillary permeability
Plasma Loss into the interstitum
= Third spacing

41
Q

A clinical finding that separetes hypovolemic shock from other shocks

A

Narrow pulse pressure
Adequate or hypotensive systolic pressure
Increased diastolic resistance - increased both to try and compensate

42
Q

Distributive shock includes

A

Septic
Anaphylactic
Neurogenic (spinal injury)

43
Q

Distributive shock is characterized by

A

dec SVR leading to maldistribution of blood volume and flow

44
Q

In septic and distributive shock there is decreased..

A

cell permeability .. leading to loss of volume from the intravascular space - decreased preload

45
Q

In neurogenic shock there is decreased..

A

sympathetic tone, leading to vasodilation and lack of compensatory mechansims

46
Q

Distributive shock characteristics

A
  1. Volume depletion due to capillary leak
  2. Rlease of inflammatory / vasoactive substances
  3. Inadequate perfusion of the splanchnic (gut and kidney)
  4. Inc blood flow to peripheral tissue beds
  5. Accumulation of lactic acid
  6. Low SVR
47
Q

The inflamatory cascade response to sepsis

A
  1. Infectious organism activates the immune system (neutrophils, monocytes, macrophages)
  2. These cells stimulate release of inflammatory mediators (cytokines)
  3. Cytokines produce vasodilation and damage to the lining of the bv causing increased cap permeability
  4. Cytokines activate the coagulation cascade (microvascular thrombosis or DIC)
  5. Specific inflammatory mediators can impair cardiac contractility and cause dysfunction
48
Q

What makes sepsis so hard to treat?

A

The variability of perfusion throughout the body

49
Q

What is septic shock caused by

A

Infectious organism that cause the small blood vessels to dilate and to leak fluid into the tissues

50
Q

What glands have insufficiency in septic shock (explain)

A

adrenal glands - prone to microvascular thrombosis

51
Q

Neurogenic shock results from what level

A

T6 and above

52
Q

What are the compensatory mechanisms of neurogenic shock

A

None due to the sympathetic system being interupted

53
Q

What separates hypovolemia from cardiogenic shock

A

Hypovolemia is quiet tachypnea

While cardiogenic is retractions, grunting, use of accessory muscles - pulmonary edema

54
Q

Fluid refill in cardiogenic shock for peds

A

5-10 ml/kg boluses over 10 to 20 minutes

55
Q

Simple pneumo

A

air leak that enters the pleural space but stops spontaneously

56
Q

Specific findings in tension pneumo

A

Tracheal deviation
Hyperresonance on the affected side
Hyperexpansion on the affected side

57
Q

PE is

A

a total or partial obstruction of the pulmonary artery or its branches by a clot, air, amniotic fluid, catheter fragment

58
Q

What is glucose used for

A

vital for proper cardiac and brain function

Hypoglycemia can lead to seizures and brain injury

59
Q

What is calcium used for

A

Cardiac function and vasomotor tone

60
Q

How does sodium bicarb work in acidosis

A

Sodium bicarb combines with hydrogen ions = carbon dioxide and water

CO2 is then eliminated through alveolar ventilation

61
Q

Fluid resuscitation rate

A

20ml/kg over 5 to 20 mins

62
Q

Inotropes work by

A

Increase cardiac contractility

Increase HR

63
Q

Inotropes drugs

A

Dopamine
Epi
Dobutamine

64
Q

Phosphodiesterase ihibitors work by

A

Decrease SVR
Improve coronary artery blood flow
Improve contractility

65
Q

Phosphodiesterase examples

A

Milrinone

66
Q

Vasodilator examples

A

Nitro

67
Q

Vasopressor examples

NEVD

A

Epi (>0.3 mcg/kg a minute)
Norephinephrine
Dopamine (>10mcg/kg a minute)
Vasopressin

68
Q

What fluid is usually used for shock

A

isotonic crystalloids will expand intravascular volume

Blood is usually only used for hemorrhage

69
Q

Other fluid rates for hypotensive and septic shock

A

60 ml/kg or 200m/kg

70
Q

DKA osmolality

A

Significantly dehydrated - hyperglycemia

71
Q

What happens with rapid fluid fix in DKA

A

Cerebral edema

72
Q

Fluid resuscitation in DKA

A

10 to 20 ml/kg over 1 to 2 hours

73
Q

Posoning fluid resuc (CCB - B blockers)

A

5-10ml/kg bolus over 10-20 mins

74
Q

Dextrose dosage for symptomatic child

A

D25W : 2-4ml/kg

D10W: 5-10ml/kg

75
Q

Hemorrhagic sock resuscitation

A

3ml of isotonic crystalloid for every 1ml of blood loss

Archived - Pediatric Advanced Life Support (PALS) 2020 (23 decks)

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