23 - Pediatrics - Shock

Question 1

What are the four forms of shock?

Answer 1

• Obstructive
• Cardiogenic
• Distributive
• Hypovolemic

Question 2

This shock may result from hemothorax, pneumothorax, or cardiac tamponade.

Answer 2

Obstructive - it obstructs venous return to the heart

Question 3

Tx. of obstructive shock

Answer 3

Pre-hospital needle decompression

Question 4

This shock may arise from sepsis,

anaphylaxis, or neurologic damage.

Answer 4

Distributive

• All these causes cause vasodilation, “distributing” blood to tissues away from the heart

Question 5

Tx of distributive shock in the pediatric patient

Answer 5

1: 20 mL/kg NS bolus
2: Consider epinephrine in the case of suspected anaphylaxis

Question 6

Congenital heart
disease, cardiac surgery,
rhythm disturbance,
post-cardiac arrest may produce this shock.

Answer 6

Cardiogenic

Question 7

Tx of cardiogenic shock in the pediatric patient

Answer 7

1: 20 mL/kg NS bolus
2: Treatment of underlying rhythm disturbance
3: 50-20 mcg/kg/min dopamine with MedCom order

Question 8

Tx of suspected hypovolemic shock in the pediatric patient.

Answer 8

20 mL/kg NS bolus repeated x1; may contact Med Com for further orders

Question 9

Triangle of death in shock

Answer 9

• Hypothermia
• Acidosis
• Coagulopathy