Blood pressure Flashcards
Compensated shock
Response activated to maintain BP to vital organs.
Uncompensated shock
aerobic to anarobic, which produces lactatea and metabolic acidenia
Causes cardiac output to fall (as the heart weakens from lack of oxygen and acid)
= BP drop
Tachycardia in the newborn
Over 180 beats per minute at rest
> poor cardiac output / congestive HF
over 220 ?SVT
Other causes - pain , fever, hypoxia, medications, hyperthyroidism
Bradycardia in the newborn
less then 100
> hypoxemia, hypotension, acidosis all cause
brady with severe shock = impending arrest
other causes - hypothermia, raised ICP, abdo distention, hypoglycemia, meds
The difference in brachial and femoral pulses?
Brachial stronger than femoral
> Coarctation of the aorta or interrupted aortic arch
Desired urine output
1 ml/kg/hour
Causes of narrow pulse pressure
peripheral vasoconstriction
HF
Compression on the heart
Severe aortic valve stenosis
Causes of wide PP
Large arotic (diastolic) run off lesion
Sepsis with vasodilated shock
3 types of shock in the infant?
Hypovolemic
Cardiogenic
Septic
Hypovolemic shock
Intrapartum stage
> placental hermorrage
> umbi cord injury
> organ lac (spleen / liver)
> fetal to maternal hem.
> twin to twin t/f syndrome
Postnatal
> scalp most common is subgaleal hem.
TREATMENT
> no acute blood loss. 10 ml / kg NS
> blood loss 10 ml / kg PRBC / whole blood (O Neg)
> want irradiated pref
Cardiogenic shock
HF occurs in infants when the heart muscle functions poorly
> intrapartum / PP asphxia
hypoxia / metabolic acidosis
bacterial / viral inf.
severe RD
severe hypoglycemia
arrhythmias
TREATMENT - underlying causes
- sod. bic. for severe metabolic acidosis
septic (distributive shock)
Hall mark - hypotension that responds POORLY to fluid resus.
Either > fluid resus or dopamine infusion
3 types of scalp swelling
- Caput succedaneum
- Cephalohematoma
- Subgaleal Hemorrahage
Caput Succedaneum
Superfinical swelling and receeds quickly
* serosanguineous fluid in the subcutaneous tissue of the scalp
* as the infant shifts this may also shift
Cephalophematoma
Membrane of fibrous connective tissue around the brain > blood gets between bone and periosteum
* initially firm and then fluctant at 48 hours
* resolves within 2 weeks to 3 months
Subgaleal Hemmorage
Subgalyeal space holdsup to 240 ml of blood (potentially entire blood volume) hence hemorrhage risk
- Venous return to the heart is via the scalp
- crosses suture lines
- “boggy”
- resolves over 2-3 weeks
- high mortality
