6 - Paeds - Surgery - Shock

Question 1

type of shock usually seen in kids? possible causes?

Answer 1

hypovolaemic due to fluid loss, maldistribution of fluid in sepsis, or intestinal obstruction

Question 2

wky kids v susceptible to hypovolaemic shock?

therefore become dehydrated if…3 points?

Answer 2

require higher fluid intake per Kg, due to larger SA:V and higher BMR

• unable to take oral fluids
• additional fluid losses due to fever, diarrhoea or insensible losses
• loss of normal fluid retaining mechanisms eg burns, preterm, urinary loss, cap leak

Question 3

Early clinical features of shock

Answer 3

compensated, BP maintained,

tachycardia, tachypnoea, decr skin turgor, sunken eyes/fontanelle, CRT >2s, mottled/pale/cold, cold peripheries, decr urine output, >10% wt loss, metabolic acidosis

Question 4

Late clinical features of shock

Answer 4

decompensated, BP falls

acidosis (kussmaul) breathing, bradycardia, decr GCS, blue peripheries, absent urine output

Question 5

Initial mgmt principle? what do you give? then what? what if no improvement?

Answer 5

fluid resus - 20ml/kg 0.9% saline or blood (if trauma)
-> improves? -> correction of hypovolaemia
no improvement? > repeat > no improvement > ICU

Question 6

Subsequent mgmt - if no improvement/progression/resp failure? 5 things that get done after this?

Answer 6

> PICU

• tracheal intubation and mechanical ventilation
• invasive monitoring of BP
• inotropic support
• correction of haem, biochemical, and metabolic derangement
• support for renal/liver failure