Circulatory Shock in Children

Question 1

definition of shock

Answer 1

-state of acute energy failure in which there is not enough ATP production to support the functions of the body

Question 2

oxygen content is determined by:

Answer 2

Hb

Question 3

low stroke volume related to:

Answer 3

• *HYPOVOLEMIA
• poor pump function
• inc afterload

Question 4

Stoke volume dependent on:

Answer 4

Preload
myocardial contractility
afterload

Question 5

Cardiac output dependent on:

Answer 5

SV and HR

Question 6

BP dependent on:

Answer 6

CO and Systemic vascular resistance

Question 7

Recognition of Shock:

Answer 7

• do not feel good
• tachycardia and pnea
• capillary refill > 2 seconds
• narrow pulse pressure or wide pulse pressure
• hypotension is late sign

Question 8

Late sign of shock in child?

Answer 8

hypotension

Question 9

HR in new born

Answer 9

145 ish and goes down as gets older

Question 10

How does child respond to shock? manifestation in child?

Answer 10

• as CO drops BP remains the same to some point because the VASCULAR RESISTANCE INCREASES
• since vascular resistance is inc the childs extremities will be cold and clammy

Question 11

Monitor organ perfusion via?

Answer 11

• brain - lethargy
• skin - pale/cold
• kidneys - foley catheter - monitor urine output

Question 12

ASsessment of shock

Answer 12

measure O2 extraction out of the blood

• check Arterioal and venous oxygen saturation
• Arterial-Venous=how much O2 is being pulled out of blood

-if in shock CO is low so blood tends to sit around=more time to extract O2!!! normal =25% can go up to 40%

Question 13

common etiologies for shock:

Answer 13

GI issue

-dehydration

Question 14

Blood volume in adults vs children:

Answer 14

• children have much more water relative to size
• if the children lose 10% of water compared to adults losing 10% then they get dehydrated much faster and much more likely circ shock

Question 15

kid with petechial or purpuric rash think:

Answer 15

shock or meningococcemia

Question 16

What is SIRS

Answer 16

Systemic inflam response syndrome

• fever
• tachycardia
• tachypnea
• white cell count abn

Question 17

Sepsis =

Answer 17

SIRS
Systemic inflam response syndrome
-fever
-tachycardia
-tachypnea
-white cell count abn

Question 18

Severe sepsis:

Answer 18

Have SIRS and…

-spesis associated with organ dysfunction, hypo-perfusion (lactic acidosis oliguria, altered mental status)

Question 19

septic shock:

Answer 19

-sepsis with perfusion abnormalities and hypotenision despite adequate fluid resuscitation

Question 20

Shcok in sepsis:

Answer 20

1) hypovolemic shock
- due to capillary leak, insensible losses, decreased effective blood volume due to venodilation
2) cardiogenic shock
- due to myocardial depression
3) distributive shock
- due to decreased SVR from pathologic vasodilation

Question 21

Risk factors for septic shock:

Answer 21

• immunodef
• asplenia
• sickle cell
• indewlling catheters

-GRAM NEG RODS MOST COMMON/TRADITIONALLY

Question 22

Shock treatment:

Answer 22

• restore metnal status
• resotre cap refil/perfusion
• aggressive volume resuscitation

Question 23

Distributive shock:

Answer 23

-Cardiac is fine but the stuff is not staying in the vessels wtf?
due to: anaphylaxis, spinal cord injury, certain toxins

Question 24

Spianl shock symptoms:

Answer 24

bradycardia and HYPOTENSION!!

usually shock has HYPERTENSION

Question 25

Common heart issue:

Answer 25

supraventricuar tachycardia - purely electrical issue

Question 26

as R heart gets bigger in children what do you see?

Answer 26

• HEPATOGMEGALLY
• pulmonary congenstion
• edema
• dec ejection fraction

-not so much jugular venous pulse