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Fa: Methods 2 > 7. PALS Shock > Flashcards

7. PALS Shock Flashcards

1
Q

shock

A

inadequate tissue perfusion

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2
Q

all forms of shock produce

A

tissue hypoxia

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3
Q

common shock symptoms

A

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

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4
Q

compensated shock

A

body mx normal BP and CO despite poor signs of perfusion

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5
Q

compensated BP

A

> 50th percentile for age

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6
Q

decompensated BP

A

< 50th percentile for age

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7
Q

decompensated shock

A

BP remains low despite compensatory efforts from the body

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8
Q

warm shock

A

caused by vasodilation

low BP
periph BF incr

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9
Q

warm shock S+S

A

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

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10
Q

cold shock

A

caused by low CO w/vasoconstriction

periph BF decr

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11
Q

cold shock S+S

A

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

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12
Q

cold shock/decompensated shock treatment

A

fluids
vasopressors
inotropes

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13
Q

warm shock treatment

A

fluids
vasopressors

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14
Q

compensated shock treatment

A

fluids
inotropes
vasodilators (cardiogenic shock)

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15
Q

most common shock in kids

A

hypovolemic shock

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16
Q

2 types of hypovolemic shock

A

hemorrhageic
non-hemorrhagic

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17
Q

hypovolemic shock S+S

A

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

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18
Q

hypovolemic shock treatment

A

20 ml/kg fluid bolus
blood

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19
Q

cardiogenic shock

A

caused by decr contractility and decr EF

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20
Q

pts with cardiogenic shock can develop

A

pulm edema
vasoconstriction (cold shock)

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21
Q

cardiogenic shock S+S

A

poor perfusion
hTN
incr SVR
vasoconstriciton
cold shock
rales

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22
Q

cardiogenic shock treatment

A

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

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23
Q

how do vasodilators incr CO

A

decr SVR

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24
Q

when can you consider vasodilators?

A

if shock is compensated (normotensive)

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25
Q

prearrest ECOM should be considered if

A

pt has cardiomyopathy
or refractory low CO

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26
Q

dissociative shock

A

abnormalities in Hb affinity:
CO poisoning
methemoglobinemia
CN poisoning

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27
Q

CO poisoning treatment

A

supp O2

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28
Q

methemoglobinemia treatment

A

methylene blue

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29
Q

obstructive shock

A

shock caused by obstruction to BF

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30
Q

4 types of obstructive shock

A

pulm embolism
cardiac tamponade
tension pneumothorax
ductal dependent lesion

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31
Q

pulm embolism S+S

A

poor perfusion
hTN
signs of RHF
resp distress/chest pain

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32
Q

pulm ebolism treatment

A

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

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33
Q

cardiac tamponade S+S

A

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

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34
Q

cardiac tamponade treatment

A

pericardiocentesis
20 mL/kg fluid bolus

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35
Q

tension pneumothorax s+s

A

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

36
Q

tension pneumo treatment

A

needle decompression
chest tube placement

37
Q

needle decompression

A

2nd-3rd intercostal space
mid-clavicular line

38
Q

chest tube placement

A

6th-7th intercostal space
mid-axillary line

39
Q

ductal dependedent lesions for pulm flow

A

TOF
pulm atresia

40
Q

ductal dependent lesions for systemic flow

A

HLHS
interrupted aortic arch

41
Q

ductal dependent lesions s+S

A

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

42
Q

ductal depended lesions treatment

A

PGE1
expert consult

43
Q

distributive shock

A

massive vasodilation leads to abnormal distribution of blood flow
relative hypovolemia

44
Q

3 types of distributive shock

A

anaphylactic
neurogenic
septic

45
Q

most common type of distributive shock

A

septic

46
Q

anaphylactic shock

A

severe allergic rxn w/massive histamine release
bronchoconstiction
systemic vasodilation

47
Q

anaphylactic shock S+S

A

hTN
edema
hives
warm shock
labored breathiong
hypoxia

48
Q

anaphylactic shock treatment

A

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

49
Q

neurogenic shock

A

occurs after spinal cord or head injury disrupts the sympathetic pathway

50
Q

pt with neurogenic shock cannot have

A

compensated shock
unable to mx BP via tachycardia/vasoconstriction

51
Q

neurogenic shock S+S

A

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

52
Q

neurogenic shock treatment

A

fluid boluses
trendelenburg (incr venous)
vasopressors
supp temp control

53
Q

spinal shock

A

acute loss of sensation and motor function after spinal injury

54
Q

autonomic dysreflexia may occur in what spinal cord injuries

A

above T6

55
Q

SIRS criteria

A
  1. Temp > 38.5 or < 36c
  2. unexplained tachycardia
  3. RR > 20
  4. WBC > 12,000
56
Q

how many SIRS criteria must be met

A

2+
one must be temp or WBC

57
Q

pt has sepsis if

A

they have SIRS + infection

58
Q

sepsis

A

infection activates immune system to release cytokines

59
Q

cytokines

A

promote vasodilation and incr cap permeability

60
Q

vasodilation/incr cap permeability causes

A

hypovolemia
decr tissue perfusion
metabolic acidosis
organ failure

61
Q

sepsis pts may suffer from

A

mitochondrial dysfunction which impairs O2 uptake leading to hypoxia

62
Q

Sepsis pts may have

A

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

63
Q

Sepsis pathway

A

SIRS
sepsis
severe sepsis
septic shock

64
Q

severe sepsis

A

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

65
Q

septic shock

A

CV dysfunction after fluid resuscitation

66
Q

septic shock diagnosis

A

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)

67
Q

septic shock treat signs of infection

A

abx
drain abcess

68
Q

septic shock: treat hTN

A

20 mL/kg fluid bolus

vasopressors (epi/NE)
inotropes
dopamine

steroids

69
Q

septic shock: treat acidosis

A

bicarb

70
Q

septic shock: treat hypoglycemia

A

dextrose

71
Q

septic shock: treat hypocalcemia

A

calcium

72
Q

septic shock: treat fever

A

antipyretics

73
Q

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

A

vasopressors
inotropes

74
Q

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

A

dopamine

75
Q

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

A

steroids

76
Q

do you treat hyperglycemia in septic shock?

A

no

77
Q

treatment for adrenal insufficiency

A

2 mg/kg hydrocortisone

78
Q

hypoglycemia treatment

A

0.5 g/kg dextrose

79
Q

hypocalcemia treatment

A

20 mg/kg ca2+

80
Q

which shocks have rales

A

cardiogenic

81
Q

which shocks have labored breathing

A

cardiogenic
obstructive
anaphylactic

82
Q

which shock has petechiae

A

septic

83
Q

which shock has jugular venous distension

A

cardiogenic
obstructive

84
Q

which shocks are warm

A

anaphylactic
septic

85
Q

which shocks are cold

A

hypovolemic
cardiogenic
obstructive

86
Q

endpoints for shock management

A

normal vitrals
good perfusion
normal labs

Fa: Methods 2 (15 decks)

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