7. PALS Shock Flashcards
shock
inadequate tissue perfusion
all forms of shock produce
tissue hypoxia
common shock symptoms
hypotension
decr CO
vasoconstriction
poor perfusion
vasodilation (sepsis/anaphylaxis)
compensated shock
body mx normal BP and CO despite poor signs of perfusion
compensated BP
> 50th percentile for age
decompensated BP
< 50th percentile for age
decompensated shock
BP remains low despite compensatory efforts from the body
warm shock
caused by vasodilation
low BP
periph BF incr
warm shock S+S
good peripheral pulses
incr CO
wider pulse pressure
warm/flushed skin
cold shock
caused by low CO w/vasoconstriction
periph BF decr
cold shock S+S
pale/mottled skin
cold peripherals
narrow pulse pressure
inaccurate BP readings
cold shock/decompensated shock treatment
fluids
vasopressors
inotropes
warm shock treatment
fluids
vasopressors
compensated shock treatment
fluids
inotropes
vasodilators (cardiogenic shock)
most common shock in kids
hypovolemic shock
2 types of hypovolemic shock
hemorrhageic
non-hemorrhagic
hypovolemic shock S+S
poor perfusion
hTN
tachycardia
incr SVR
vasoconstriction
cold shock
clear breath sound
hypovolemic shock treatment
20 ml/kg fluid bolus
blood
cardiogenic shock
caused by decr contractility and decr EF
pts with cardiogenic shock can develop
pulm edema
vasoconstriction (cold shock)
cardiogenic shock S+S
poor perfusion
hTN
incr SVR
vasoconstriciton
cold shock
rales
cardiogenic shock treatment
smaller 5-10 mL fluid bolus over 20 mins
inotropes
vasodilators
diuretics
how do vasodilators incr CO
decr SVR
when can you consider vasodilators?
if shock is compensated (normotensive)
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
- Temp > 38.5 or < 36c
- unexplained tachycardia
- RR > 20
- 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?
no
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
