7. PALS Shock Flashcards by Kira Harms

shock

inadequate tissue perfusion

How well did you know this?

Not at all

Perfectly

all forms of shock produce

tissue hypoxia

How well did you know this?

Not at all

Perfectly

common shock symptoms

hypotension
decr CO
vasoconstriction
poor perfusion
vasodilation (sepsis/anaphylaxis)

How well did you know this?

Not at all

Perfectly

compensated shock

body mx normal BP and CO despite poor signs of perfusion

How well did you know this?

Not at all

Perfectly

compensated BP

> 50th percentile for age

How well did you know this?

Not at all

Perfectly

decompensated BP

< 50th percentile for age

How well did you know this?

Not at all

Perfectly

decompensated shock

BP remains low despite compensatory efforts from the body

How well did you know this?

Not at all

Perfectly

warm shock

caused by vasodilation

low BP
periph BF incr

How well did you know this?

Not at all

Perfectly

warm shock S+S

good peripheral pulses
incr CO
wider pulse pressure
warm/flushed skin

How well did you know this?

Not at all

Perfectly

cold shock

caused by low CO w/vasoconstriction

periph BF decr

How well did you know this?

Not at all

Perfectly

cold shock S+S

pale/mottled skin
cold peripherals
narrow pulse pressure
inaccurate BP readings

How well did you know this?

Not at all

Perfectly

cold shock/decompensated shock treatment

fluids
vasopressors
inotropes

How well did you know this?

Not at all

Perfectly

warm shock treatment

fluids
vasopressors

How well did you know this?

Not at all

Perfectly

compensated shock treatment

fluids
inotropes
vasodilators (cardiogenic shock)

How well did you know this?

Not at all

Perfectly

most common shock in kids

hypovolemic shock

How well did you know this?

Not at all

Perfectly

2 types of hypovolemic shock

hemorrhageic
non-hemorrhagic

How well did you know this?

Not at all

Perfectly

hypovolemic shock S+S

poor perfusion
hTN
tachycardia
incr SVR
vasoconstriction
cold shock
clear breath sound

How well did you know this?

Not at all

Perfectly

hypovolemic shock treatment

20 ml/kg fluid bolus
blood

How well did you know this?

Not at all

Perfectly

cardiogenic shock

caused by decr contractility and decr EF

How well did you know this?

Not at all

Perfectly

pts with cardiogenic shock can develop

pulm edema
vasoconstriction (cold shock)

How well did you know this?

Not at all

Perfectly

cardiogenic shock S+S

poor perfusion
hTN
incr SVR
vasoconstriciton
cold shock
rales

How well did you know this?

Not at all

Perfectly

cardiogenic shock treatment

smaller 5-10 mL fluid bolus over 20 mins
inotropes
vasodilators
diuretics

How well did you know this?

Not at all

Perfectly

how do vasodilators incr CO

decr SVR

How well did you know this?

Not at all

Perfectly

when can you consider vasodilators?

if shock is compensated (normotensive)

How well did you know this?

Not at all

Perfectly

prearrest ECOM should be considered if

pt has cardiomyopathy or refractory low CO

dissociative shock

abnormalities in Hb affinity: CO poisoning methemoglobinemia CN poisoning

CO poisoning treatment

supp O2

methemoglobinemia treatment

methylene blue

obstructive shock

shock caused by obstruction to BF

4 types of obstructive shock

pulm embolism cardiac tamponade tension pneumothorax ductal dependent lesion

pulm embolism S+S

poor perfusion hTN signs of RHF resp distress/chest pain

pulm ebolism treatment

20 mL/kg fluid bolus anticoags (heparin) thrombolytics (tPA) expert consult

cardiac tamponade S+S

poor perfusion hTN becks triad pulsus paradoxus resp distress/chest pain

cardiac tamponade treatment

pericardiocentesis 20 mL/kg fluid bolus

tension pneumothorax s+s

resp distress poor signs of perfusion low SpO2 unilateral hyperresonant breath sounds tracheal deviation (contralateral) distended jugular veins

tension pneumo treatment

needle decompression chest tube placement

needle decompression

2nd-3rd intercostal space mid-clavicular line

chest tube placement

6th-7th intercostal space mid-axillary line

ductal dependedent lesions for pulm flow

TOF pulm atresia

ductal dependent lesions for systemic flow

HLHS interrupted aortic arch

ductal dependent lesions s+S

rapid deterioration in consciousness CHF BP/SpO2 difference in pre/post ductal circulation

ductal depended lesions treatment

PGE1 expert consult

distributive shock

massive vasodilation leads to abnormal distribution of blood flow relative hypovolemia

3 types of distributive shock

anaphylactic neurogenic septic

most common type of distributive shock

septic

anaphylactic shock

severe allergic rxn w/massive histamine release bronchoconstiction systemic vasodilation

anaphylactic shock S+S

hTN edema hives warm shock labored breathiong hypoxia

anaphylactic shock treatment

epi bronchodilators 20 mL/kg fluid bolus corticosteroids H1/H2 blockers O2 BiPaP intubation

neurogenic shock

occurs after spinal cord or head injury disrupts the sympathetic pathway

pt with neurogenic shock cannot have

compensated shock unable to mx BP via tachycardia/vasoconstriction

neurogenic shock S+S

spinal cord/head injury vasodilation wide pulse pressure hTN bradycardia or normal HR

neurogenic shock treatment

fluid boluses trendelenburg (incr venous) vasopressors supp temp control

spinal shock

acute loss of sensation and motor function after spinal injury

autonomic dysreflexia may occur in what spinal cord injuries

above T6

SIRS criteria

1. Temp > 38.5 or < 36c 2. unexplained tachycardia 3. RR > 20 4. WBC > 12,000

how many SIRS criteria must be met

2+ one must be temp or WBC

pt has sepsis if

they have SIRS + infection

sepsis

infection activates immune system to release cytokines

cytokines

promote vasodilation and incr cap permeability

vasodilation/incr cap permeability causes

hypovolemia decr tissue perfusion metabolic acidosis organ failure

sepsis pts may suffer from

mitochondrial dysfunction which impairs O2 uptake leading to hypoxia

Sepsis pts may have

mitochondrial dysfunction adrenal insufficiency hyper/hypoglycemia hypocalcemia incr CO (early) decr CO (late) repiratory alkalosis (early) respiratory acidosis (late)

Sepsis pathway

SIRS sepsis severe sepsis septic shock

severe sepsis

sepsis + 1 of the following: CV dysfunction ARDS 2+ organ failure

septic shock

CV dysfunction after fluid resuscitation

septic shock diagnosis

signs of infection poor perfusion hypoxia petechiae metabolic acidosis/incr lactate adrenal insufficiency hypo/hyperglycemia hypocalcemia incr CO (early vasodilation) decr CO (late myocardial dysfunction)

septic shock treat signs of infection

abx drain abcess

septic shock: treat hTN

20 mL/kg fluid bolus vasopressors (epi/NE) inotropes dopamine steroids

septic shock: treat acidosis

bicarb

septic shock: treat hypoglycemia

dextrose

septic shock: treat hypocalcemia

calcium

septic shock: treat fever

antipyretics

what should you consider for hTN in septic shock that does not respond to fluid boluses?

vasopressors inotropes

what can you give in septic shock if vasopressors are unavailable?

dopamine

what can you give in septic shock if pt is still hTN after fluids and vasopressors?

steroids

do you treat hyperglycemia in septic shock?

treatment for adrenal insufficiency

2 mg/kg hydrocortisone

hypoglycemia treatment

0.5 g/kg dextrose

hypocalcemia treatment

20 mg/kg ca2+

which shocks have rales

cardiogenic

which shocks have labored breathing

cardiogenic obstructive anaphylactic

which shock has petechiae

septic

which shock has jugular venous distension

cardiogenic obstructive

which shocks are warm

anaphylactic septic

which shocks are cold

hypovolemic cardiogenic obstructive

endpoints for shock management

normal vitrals good perfusion normal labs