Cardiogenic shock in pediatric patients

Question 1

definition: CO

Answer 1

SV x HR

Question 2

definition: cardiogenic shock

Answer 2

heart fails as a pump to provide adequate circulation to meet the metabolic needs of the body

Question 3

equation: BP

Answer 3

CO plus systemic vascular resistance (SVR)

Question 4

is CO mroe strongly influenced by HR or SV? why?

Answer 4

HR

children do not have as much ventricular muscle mass

Question 5

what is the response to decreased CO in children?

Answer 5

VT

Question 6

what does it mean when kids have VT?

Answer 6

cardiogenic shock

Question 7

SV is dependent upon which three factors?

Answer 7

preload
contractility
afterload

Question 8

what are the effects on preload, afterload, and contractility in cardiogenic shock?

Answer 8

increased preload
increased afterload
DECREASED contractility

Question 9

what are the effects on preload, afterload, and contractility in hypovolemic shock?

Answer 9

decreased preload
increased afterload
normal contractility

Question 10

what are the general (and specific) causes of cardiogenic shock?

Answer 10

acquired - rheumatic fever, cardiomyopathies
non-cardiac - pneumothorax, hyperkalemia, hypocalcemia
congenital heart disease - large ventricular septal defects

Question 11

what is the child’s principal means of maintaining CO?

Answer 11

tachycardia

Question 12

what studies / tests are done to assess and diagnose cardiogenic shock? which is most specific?

Answer 12

ECG
chest radiography
ECHOCARDIOGRAPHY (most specific)

Question 13

what lab tests are done to assess and diagnose cardiogenic shock? which is most crucial?

Answer 13

glucose (most crucial) 
electrolytes 
calcium 
blood gases 
cardiac enzymes 
viral titers

Question 14

what is the goal of treating cardiogenic shock?

Answer 14

improve oxygen delivery to all organs

Question 15

neonates with ductal-dependent lesions in cardiogenic shock should be treated with what agent? why?

Answer 15

PGE1

maintain patent ductus arteriosus

Question 16

when should you use PGE1?

Answer 16

neonates with ductal-dependent lesions in cardiogenic shock to maintain patent ductus arteriosus

Question 17

what agents can be considered early to prevent volume overload in cardiogenic shock?

Answer 17

inotropic agents - DA, dobutamine, EPI

Question 18

which agents increase SV by reducing afterload?

Answer 18

milrinone
nitroprusside
inhaled NO

Question 19

which agents should be avoided in cardiogenic shock because of their potent vasoconstrictive effects, worsening afterload?

Answer 19

phenylephrine and NE