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Archived - Pediatric Advanced Life Support (PALS) 2020 > 2 - Shock Overview > Flashcards

2 - Shock Overview Flashcards

1
Q

What are the two types of shock you should be able to differentiate between?

A

compensated and hypotensive

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2
Q

True or false?

Shock can be present with or without hypotension?

A

true

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3
Q

Shock that results from inadequate blood volume or oxygen carrying capacity is called

A

hypovolemic shock, including hemorrhagic shock

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4
Q

Shock that results from inappropriate distribution of blood volume and flow is called what?

A

distributive shock

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5
Q

Shock that results from impaired cardiac contractility is called what?

A

cardiogenic shock

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6
Q

Shock that results from obstructed blood flow is called what?

A

obstructive shock

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7
Q

In this clinical condition, there are clinical signs of inadequate tissue perfusion, but the blood pressure is in the normal range.

A

Compensated shock

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8
Q

What are some signs of compensated shock referring to the organs; skin 4, heart 1, pulses 2, kidneys 1, intestines 2, and brain 3

A
  • heart - tachycardia
  • skin - cold, pale, mottled, diaphoretic
  • Pulses - weak, narrow pulse pressure
  • kidneys - oliguria
  • Intestines - vomiting, ileus
  • brain - AMS, anxiety/restless, disorientation
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9
Q

Another name for hypotensive shock is what

A

decompensated shock

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10
Q

What is the formula to determine is hypotension is present in a child?

A

70 mmHg + (childs age x 2)

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11
Q

How long can it take for compensated shock to progress into decompensated shock

A

it can take a matter of hours

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12
Q

How long can it take for decompensated shock to progress into cardiac arrest?

A

potentially minutes

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13
Q

What are some possible causes of hypovolemic shock?

(5)

A
  • gastroenteritis (vomiting),
  • burns,
  • hemorrhage,
  • inadequate fluid intake,
  • osmotic diuresis (DKA)
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14
Q

What are some possible causes of cardiogenic shock ?

(4)

A
  • congenital heart disease,
  • myocarditis,
  • cardiomyopathy,
  • arrhythmia
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15
Q

What are some possible causes of distributive shock?

(3)

A
  • sepsis,
  • anaphylaxis,
  • spinal cord injury
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16
Q

What are some possible causes of Obstructive shock?

(4)

A
  • tension pneumothorax,
  • cardiac tamponade,
  • pulmonary embolism,
  • constriction of the ductus arteriosus
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17
Q

______ shock refers to the clinical state of characterized by reduced SVR leading to _______ of blood volume and blood flow, such as with septic, anaphylactic, and neurogenic shock

A
  • distributive shock
  • maldistribution
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18
Q

What are three different types of distributive shock?

A
  • septic shock
  • anaphylactic shock
  • neurogenic shock
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19
Q

The most common type of of distributive shock is

A

septic shock

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20
Q

Neurogenic shock is also known as _____ shock

A

spinal

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21
Q

What are the three primary signs of neurogenic shock

A
  • hypotension with a wide pulse pressure
  • normal heart rate or bradycardia
  • hypothermia
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22
Q

This type of shock is the result of abnormal cardiac function or pump failure

A

cardiogenic shock

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23
Q

_____ shock refers to conditions that physically impair blood flow by limiting venous return to the heart or limit the pumping of blood from the heart

A

obstructive shock

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24
Q

What are 4 common causes in pediatrics that can cause obstructive shock?

A
  • pericardial tamponade
  • tension pneumothorax
  • ductal-dependent congenital heart defects
  • massive pulmonary embolism
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25
Q

Name 5 goals in the treatment of shock

A
  • Improve O2 delivery
  • Balance tissue perfusion &metabolic demand
  • Reverse perfusion abnormalities
  • Support organ function
  • Prevent progression into cardiac arrest
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26
Q

Warning signs that indicate progression from compensated shock to hypotensive shock include (4)

A
  • Narrowing pulse pressure
  • Hypotension
  • Decreasing LOC
  • Weakening central pulses
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27
Q

Name 4 things that can result in hyperkalemia

A
  • renal dysfunction
  • cell death
  • excess potassium administration
  • acidosis
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28
Q

How does acidosis cause hyperkalemia?

A

Acidosis causes a shift in potassium from the intracellular to the extracellular space, including the intravascular.

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29
Q

_____ _____ develops from the production of acids, such as lactic acid, when tissue perfusion is inadequate.

A

metabolic acidosis

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30
Q

How does sodium bicarb help resolve acidosis?

A

Acts as a buffer by combining with hydrogen ions to produce CO2 and water

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31
Q

In general, isotonic crystalloid should be given in a __ml/kg bolus over __ to __ minutes, unless you suspect _____ shock

A
  • 20 ml/kg over 5 to 20 minutes
  • cardiogenic
32
Q

In cardiogenic shock, fluid resuscitation consists of __ to __ ml/kg given over __ to __ minutes.

A
  • 5 to 10 ml/kg
  • 10 to 20 minutes
33
Q

The expected urine output for infants and young children is about __ to __ ml/kg per hour

A

1.5 to 2

34
Q

What do inotropes do?

A

Increase cardiac contractility and heart rate

35
Q

Dopamine, epinephrine, and dobutamine are all what

A

Inotropes

36
Q

What is a phosphodiesterase inhibitor?
Give one example

A
  • Decreases SVR
    • Improves coronary artery blood flow
    • Improves contractility
      • ex. Milrinone
37
Q

Give two examples of a vasodilator

A
  • Nitroglycerin
  • Nitroprusside
38
Q

Blood and blood products are generally not used for volume expansion in children with shock unless shock is due to what

A

Hemorrhage

39
Q

For children that have been poisoned, such as have ingested calcium channel blockers, give fluid resuscitation of __-__ ml/kg over __-__ minutes

A
  • 5-10 ml/kg
  • Over 10-20 minutes
40
Q

A pediatric patient in DKA should receive fluid resuscitation at the rate of __-__ ml/kg over what amount of time?

A
  • 10 - 20
  • over a matter of time governed by local protocol, if used give over at least 1 - 2 hours
41
Q

Hypoglycemia in preterm neonates and term neonates is defined as a blood sugar below what

A

45

42
Q

For the purposes of the PALS Provider course, shock is categorized into 4 types, what are they?

A
  • hypovolemic
  • distributive
  • cardiogenic
  • obstructive
43
Q

Clinically significant dehydration in children is generally associated with at least __% volume depletion, corresponding with a fluid deficit of __ ml/kg or greater

A
  • 5 %
  • 50 mL/kg
44
Q

Shock may be observed in children with fluid deficits of __ to __ ml/kg, but is more consistently observed with deficits of __ ml/kg or greater

A
  • 50 to 100
  • 100
45
Q

Failure to improve after 3 boluses of 20 ml/kg may indicate what?

(4)

A
  • The extent of fluid losses may be underestimated
  • They type of fluid being used may need to be altered (eg, colloid or blood)
  • There are ongoing fluid losses (eg, occult bleeding )
  • Your initial assumption about the etiology of the shock may be incorrect
46
Q

In children, the dividing line between mild and compensated vs moderate to severe hypotensive hemorrhagic shock is thought to correlate with an acute loss of about __% of blood volume.

A

30

47
Q

The estimated total blood volume of a child is about __ to __ ml/kg.

A

75 - 80

48
Q

For fluid resuscitation in hemorrhagic shock, give about __ ml of isotonic crystalloid for every __ ml of blood lost

A
  • 3
  • 1
  • known as the 3 to 1 rule
49
Q

Name three types of distributive shock

A
  • Septic
  • Anaphylactic
  • Neurogenic
50
Q

What is the difference between primary and secondary bradycardia?

A

Primary bradycardia:

  • Primary bradycardia is the result of congenital abnormalities or acquired injury to the heart’s pacemaker cells or conduction system.*
  • Some of the causes of primary bradycardia are myocarditis, surgical injury, cardiomyopathy, and congenital abnormalities of the heart or the heart’s conduction system.

Secondary bradycardia:

  • Secondary bradycardia is caused by non-cardiac problems*.
  • These problems result in abnormal functioning of the heart. Secondary bradycardia is typically the type of bradycardia seen in infants and children.
51
Q

What are some causes of secondary bradycardia?

(5)

A
  • hypoxia
  • acidosis
  • hypotension
  • hypothermia
  • drug effects
52
Q

What is the dose per IV/IO for epinephrine?
What is the dose per ET tube?

A
  • 0.01 mg/kg per IV/IO
  • ET tube 0.1 mg/kg
53
Q

What is the dose for atropine via the IV/IO route?

A
  • 0.02 mg/kg; minimum 0.1 mg, maximum 0.5 mg
    • may repeat dose once, five minutes after the first
54
Q

What is the dose for atropine via the ET tube route?

A

0.04 to 0.06 mg/kg

55
Q

For infants in SVT in need of a vagal maneuver, what is the preferred method?

A
  • ice bag to the face
  • older children who can cooperate may blow through a straw
56
Q

What is the drug of choice for the treatment of SVT?
What is the dose?

A
  • Adenosine
    • 0.1 mg/kg, max initial dose 6 mg as rapid IV bolus
57
Q

If the first dose of adenosine is effective, the rhythm will convert within __ to __ seconds. If not, what is the second dose?

A
  • 15 to 30 seconds
    • 0.2 mg/kg, max 2nd dose is 12 mg
58
Q

What is a common cause of adenosine failure?

A

Not pushed fast enough or not with an adequate fluid bolus

59
Q

ABG values

What is the normal range for pH?

A

7.35 - 7.45

60
Q

ABG values

What is the normal range for PO2?

A

80 - 100 mmHg

61
Q

ABG values

What is the normal range for PCO2?

A

35 - 45 mmHg

62
Q

ABG values

What is the normal range for HCO3 (bicarb)?

A

22 - 28 mEq/L

63
Q

What are the 4 ABG lab values?

A
  • O2
  • PCO2
  • pH
  • Bicarb HCO3
64
Q

What is a way to relieve gastric inflation post ROSC?

A

insert a G tube

65
Q

What is the DOPE mnemonic and what is used for?

A
  • Displacement of the tube; may be out of the trachea and into the right or left bronchus
  • Obstruction of the tube
  • Pneumothorax; stated as above, look for midline trachea
  • Equipment failure
  • Sudden deterioration of the intubated patient
66
Q

Give 3 reasons during post ROSC that you should use a neuromuscular block

A
  • High peak or mean airway pressure caused by high airway resistance or reduced lung compliance
  • Patient / ventilator asynchrony
  • Difficult airway
67
Q

When using a neuromuscular block, what are 3 things you should keep in mind that the block can mask or doesn’t do?

A
  • The block can mask seizures
  • Does not provide pain relief
  • Does not provide sedation
68
Q

When using a neuromuscular block on a child with an ET tube, what are 5 things you should look for signs of?
Why?

A
  • Look for signs of stress, tachycardia, hypertension, pupil dilation, and tearing.
  • Neuromuscular blocks do not provide analgesia or sedation.
69
Q

If a child has an elevated anion gap but a normal lactate, what should you look for?

A

Other causes of acidosis, such as toxins or uremia

70
Q

What is the lab value used to monitor metabolic acidosis?

A

lactic acid, anion gap

71
Q

What does SVR stand for?

A

Systemic Vascular Resistance
pg 289

72
Q

What are three drugs to consider after a child remains hypotensive after a fluid bolus administration?

A
  • Epinephrine
  • Dopamine
  • Norepinephrine
73
Q

What is the drip rate for a hypotensive child treated with epinephrine?

A

0.1 - 1 mcg/kg per minute

74
Q

What is the drip rate for a hypotensive child treated with Dopamine?

A

10 - 20 mcg/kg per minute

75
Q

What is the drip rate for a hypotensive child treated with Norepinephrine?

A

0.1 - 2 mcg/kg per minute

76
Q

If a child is normotensive and remains poorly perfused after bolus administration, name 5 drugs you may consider.

A

Dobutamine
Dopamine
Low dose epinephrine
Milrinone
inamrinone

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

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