Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Advanced Paediatric Life Support (APLS) > Chapter 5 The child in shock > Flashcards

Chapter 5 The child in shock Flashcards

1
Q

How does acidosis affect myocardial contractility and the affect of catecholamines?

A

Decreases myocardial contractility
Decreased effective of catecholamines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the 5 categories of shock?

A

Hypovolaemic
Distributive
Cardigenic
Obstructive
Dissociative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are some features of toxic shock syndrome?

A

Generalised erythema
Conjunctivitis
Mucositis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What urine output is the target in children?

A

1ml/kg/hr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

You have given multiple fluid boluses, you are considering a furthe fluid bolus and are thinking about using albumin, is there much evidence for this?

A

Not very good evidence but still worth considering if you’ve already given 20ml/kg of crystaloid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What patients might you consider more judicious fluid boluses (5-10ml/kg)

A

cardiogenic shock
Raised ICP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

After how much fluid should you consider starting inotropes?

A

20ml/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

After how many fluid boluses in the setting of shock would you consider intubation to reduce energy demand of the child?

A

40ml/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What antibiotic do you give for septicaemia without clear cause?

A

Age < 2 months
Ampicillin (aged dependent if < 1 month) (if < 1 month 50mg/kg IV ever 6 hours max 2g
PLUS
Gentamycin (if < 1 month age dependent dosing) (>1 month 7.5mg/kg IV once daily max 320mg)

Age > 2 months
Ceftriaxone 100mg/kg IV once daily max 4 g daily
or cefotaxime 50mg/kg IV 6 hourly max 2g /dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

In shock from haemorrhage, after what volume of crystaloid resuscitation should you consider activation of massive transfusion protocol?

A

5-10ml/kg of crystaloids if there is no response to this

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What joules do you use for cardioversion for shock secondary to a tacycarrhythmia?

A

1st shock: 1J/kg
2nd shock: 2J/kg
3rd shock 2J/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Is adenosine acceptable to use in a shocked child from SVT?

A

Yes, if you can give it as quickly as you can delivery and shock + provide sedation for the shock (often it is quicker to use adenosine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the dose of adrenaline for shock secondary to anaphylaxis?

A

10microg/kg IM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

True or false, hypoglycaemia can mimick compensated shock?

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the main causes of heart failure in an older child?

A

Myocarditis
Cardiomyopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the causes of shock in trauma?

A

Haemorrage (no. 1)
Tension pneumothorax
Haemothorax
Tamponade
Spinal cord transection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

In gastroenteritis with shock, what fluid bolus should you give and how many does it usually take to restore adequate circulatory volume

A

20ml/kg
Repeat if needed
Two boluses is usually enough

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

When should you start NG feeds in gastroenteritis with shock?

A

Immediately , can start concurrently with IV fluid boluses. Speeds up recovery.
Aim to restart normal normal feeding with feeding within 4-6 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

In severe gastroenteritis, a child may convulse due to hyponatraemia. How much and how fast can you given Na+ replacement?

A

3% 3ml/kg over 15-30 minutes
Until Na 125mmol/L OR when seizure terminates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

In asymptomatic hyponatramia, what is the maximum rate of correction per day you want to achieve?

A

Increase Na+ no more than 8 -12 mmol/L/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

In young children with diarrhoea and vomiting, what are the other gut pathologies other than gastroenteritis that can present this way?

A

Volvulus
Intersusspection
Appendicitis

Get an XRAY or USS to investigate these

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Can sepsis and toxic shock syndrome mimick an acute abdomen?

A

Yes, give antibiotics early

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

After how many fluid boluses should you definitely consider inotropes and or intubation if not already done?

A

3rd 20ml/kg fluid bolus
Definitely inotropes, strongly consider intubation to reduce oxygen demand and prevent pulmonary oedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is it important to place a urinary catheter in shocked patients?

A

To monitor fluid status/renal perfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What organism is responsible for the majority of infant and child septicaemia
Neisseria meningitidis
26
What organisms frequently infect very young children/infants?
Group A and streptococcal Gram negative rods from urosepsis This is why amoxycilin and gentamycin is used in sepsis of young childre
27
A maculopapular rash may prodcede a purpuric one in meningococcal septicaemia. True or false?
True
28
How may toxic shock syndrome appear in a child?
High ever Diffuse erythema or scarlantiform rash Subcutaneous oedema Desquamation Mucosal hyperaemia (strawberry tongue) Vomiting Watery diarrhoea + possible source of infection: wound, pneuomonia, osteomyelitsi
29
In a 24 hourp period, how many ml/kg may be needed to treat septic shock?
200ml/kg i.e 2.5 x the blood volume
30
What antibiotic covers listeria in what age group should you add this on when covering for sepsis
Penicillins - benzylpenicillin or amoxycilin Age < 3 months
31
Do the third generation cephalosporins (ceftriaxone/cefotaxime) have good staphylococcal cover?
No, add on specific staphyloccal covered if worried about toxic shock
32
When should you use cefotaxime over ceftiaxone?
Premature or jaundiced infants In hypoalbuminaemia If calcium infusion is needed
33
What antibiotic do you use to cover hospital aquired sepsis or neutropaenic sepsis?
Piptaz
34
What antibiotic covered extended spectrum beta lactamase producers?
Meropenem
35
If a vascular access device has been used for more than 48 hours, what antibiotic should you add on?
Vancomycin
36
Before you give hydrocortisone for refractory shock or suspected adrenal insufficency, what blood test should you order
Cortisol
37
What is the dose of dopamine for shock in children?
10 microg/kg/min
38
If a child has signs of hypodynamic shock with high systemic vascuar resistance (cold extermities) what inotrope would you use first 1) Adrenaline or dopamine OR 2) Noradrenaline
1) Adrenaline or dopamine
39
In a child with hyperdynamic shock with low systemic vascular resistance (warm peripheries) what inotrope might you consider first?
Noradrenaline if all you need is vasoconstriction. Caution - watch for reflex bradycardia
40
What is the dose of adrenaline in shock?
0.05 to 2 microg/kg/min
41
In a septic shock, what PCR tests should you order for specific organisms?
PCR meningo/streptococcal
42
What takes precedence: treatment of shock or treatment or raised ICP?
Treat shock as a priority even at the compromised of further increasing the ICP
43
What is the dose of hydrocortisone for children for the following age groups? 1) < 6 months 2) 6 months to 6 years 3) 6 - 12 years 4) > 12 years
1) 25mg 2) 50mg 3) 100mg 4) 200mg
44
What is the bolus dose of IV adrenaline for anaphylaxis?
1 microg/kg IV Dilute to 10ml to allow push over 1 min
45
What features suggest a cardiac cause of circulatory inadequacy?
Cyanosis not correcting with O2 Tachycardia out of proportion to respiratory difficulty Raised JVP Gallop heart rhythm Enlarged hear on CXR Enlarged liver Absent femoral pulses
46
What are some duct-dependent pulmonary circulation diseases of the newborn and what is key feature that makes them stand out from duct dependent systemic circulatory disease?
Pulmonary atresia Critical pulmonary stenosis Tricuspid atresia Tetralogy of fallot Hypoxia, central cyanosis without much respiratory distress and doesn't improve with O2
47
Name a few duct-dependent circulatory disease of the newborn and describe how they look different to duct-dependent pulmonary disease of the new born?
Coartication of the aorta Critical aortic stenosis Hypoplastic left heart syndrome Interrupted aortic arch Ash grey with severe metabolic acidosis and organ dysfunction Poor urine output, decreased GCS Pulses very difficult to feel, may feel difference between brachial and femoral pulses
48
Is transposition of the great vessels a pulmonary or systemic duct-dependent disease or something else?
It's both!
49
What medication is use to reopen a closing ductus arteriosis?
Alprostadil (Prostaglandin E1)
50
What is the dose of alprostadil to reopen a closing ductus arteriosis?
10 (if not too sick) to 20 nanogram/kg/min (sick) If no response in 1st hour increase to 50 nanogram/kg/min
51
In a child with suspected left sided obstruction being treated with alprostadil, what is your end goal?
palpable pulses and normal pH & lactate
52
For suspected right sided heart disease being treated with alprostadil, what is your end goal?
SpO2 75 - 85% and normal lactate
53
What side effect can you expect when using alprostadil?
Apnoeas - may need ventilatory support Vasodilation - may need fluid bolus
54
Where should your sats probe be when suspecting duct-dependent shock?
Pre and post ductal blood should be monitored (left and right side)
55
In heart failure, what is the dose of frusemide?
0.5 to 1mg/kg IV
56
What colour will the urine be if anaemia is due to acute haemolysis?
brown
57
What are the most common causes of acute anaemia in children?
Sick cell disease Haemolytic uraemic syndrome Malaria
58
When giving a blood transfusion for severe anaemia, what drug might you have to use at the same time if the child is already showing signs of heart failure?
Frusemide 0.5 to 1mg/kg IV
59
What is the standard therapy for the various forms of sickle crisis?
O2 therapy Rehydration Antibiotics Analgesia
60
In ml/kg what is the circulatory volume of a child?
80ml/kg
61
O- blood can be made available straight up and a full cross match takes about 60 minutes. What is the in-between option?
ABO resus matched blood. Only takes 15 minutes but better than O negative
62
What are the causes of bardycardia in children
Pre-terminal event in hypoxia or shock Raised ICP Conduction pathway damange post cardiac surgery Congenital heart block Long QT syndrome
63
What are the causes of tachyarrhythmias in children?
Re-entrant congenital pathway abnormalities (common) Poisoning Metabolic disturbance After cardiac surgery Cardiomyopathy Long QT syndrome
64
What is the dose of atropine for bradycardia?
20mcg/kg (min dose 100mcg, max 600 mcg) Can repeat, max total dose 1mg in child, 2mg in adolescent
65
How many joules for a sychnronised shock for VT
2J/kg
66
What is the dose of adenosine for treatment of SVT? How is the dose diferent for a neonate?
100microg/kg up to 500 mcg/kg (max dose in neonate 300mcg/kg)
67
What is the push dose of adrenaline for bradycardia? How do you give it?
10mcg/kg IV slowly titrate, don't push it all at once
68
What is the dose of an adrenaline infusion for bradycardia?
0.05 to 2 microg/kg IV
69
If p waves are present in SVT, how are they different to normal p waves?
Usually inverted, odd morphology
70
How can you apply vagal manoevres to a young child?
Glove filled with ice to face Dunk infants face in ice bath
71
What are the causes of VT in children?
Congenital heart disease or heart surgery Myocarditis Cardiomyopathy Poisoning (TCA) Renal disease (high K+) Channelopathies (long QT)
72
What is the dose of amiodarone in a stable child in SVT
5mg/kg over 20 minutes, 30 minute in neonates
73
In cases of toxic VT (from overdose) what is the best option - amiodarone or DC shock
DC shock
74
What do you do if you are trying to give a synchronised shock for VT but it won't deliver shock?
Take of the sync
75
What is the treatment of torsades de points VT?
DC cardioversion the IV magnesium 25 - 50mg/kg over a few minutes
76
What are your next steps for VT if you have tried giving a 2J/kg DC shock but that patient won't cardiovert?
Increased to 4J/kg Give amiodarone 5mg/kg over 20 min the trying shocking
77
Why should giving adenosine to a wide complex tachycardia (unsure if SVT with abberancy or VT but pt stable) be avoided or be very very cautious if doing so?
If its VT adenosine can increase the tachycardia and cause deterioration. Give DC shock

Advanced Paediatric Life Support (APLS) (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions