CLIPP 23: 15 y/o with lethargy and fever Flashcards
List 3 general physiologic states of emergency conditions causing AMS
Hypoxia, shock and hypoglycemia
In each of these, there is a lack of cellular substrate. All must be reversed quickly to prevent cellular damage. Identifying and treating these conditions is the focus of the primary assessment of critically ill patients
What is the most sensitive measure of adequacy of circulation/volume status?
Heart Rate
Heart rate is a very sensitive measure of volume status. Tachycardia is the first and most subtle sign of possible inadequate perfusion. It is the most commonly missed finding in patients who have been sent home and return with serious illness.
After assessing the ABC’s in a patient, what does the D and E (next steps) represent?
D- dextrose; assess for hypoglycemia
D- Disability; look for any signs of increased intracranial pressure/ toxic poisoning
E- Exposure and environment; make sure patient is warm while assessing
What defines shock?
Shock is defined physiologically as inadequate delivery of substrates and oxygen to meet the metabolic needs of tissues:
As cells are starved of oxygen and substrate, they can no longer sustain metabolism.
Eventually, cellular metabolism is no longer able to generate enough energy to power the components of cellular homeostasis, leading to disruption of cell-membrane ionic pumps.
The cell swells, the cell membrane breaks down, and cell death occurs
Does not absolutely require hypotension
Why is blood pressure not the best vital sign to assess shock in the pediatric population?
Children can maintain a normal blood pressure until they are in profound shock.
Because children compensate so well in early shock, hypotension is a late sign of shock
What is distributive shock?
Includes neurogenic and anaphylactic; some authors also include septic shock in this category
All of these conditions are characterized by an intravascular hypovolemia caused by:
Vasodilation
Increased capillary permeability
Third-space fluid losses
Which is the most common type of shock worldwide?
Hypovolemia
Results from inadequate fluid intake to compensate for fluid output (e.g., vomiting, diarrhea, hemorrhage.
What are 4 associations with cardiogenic shock in the pediatrics population?
Severe congenital heart disease
Dysrhythmias
Cardiomyopathy
Tamponade
What is compensated “warm” shock?
Initial presentation of septic shock, characterized by; Warm extremities Bounding pulses Tachycardia Tachypnea Adequate urination Mild metabolic acidosis
Fluid boluses should always be done with which type of fluid? At what rate?
Isotonic
20 mg/kg over 5-20 minutes
What is the protocol for resuscitation in the pediatric population?
Three boluses (60 mg/kg) and then turn to ionotropic support
What three sites can a central line be placed?
Femoral, IJ, subclavian
Two physiologic risk factors for meningococcal meningitis
Complement deficiency
Anatomic or functional asplenia
Sequelae of meningococcal disease?
Hearing loss
Neurologic disability
Loss of digit/s or limb/s
Scarring
Meningitis prophylaxis for close contacts?
All household contacts and anyone having close contact during management of the patient should be treated: ciprofloxacin for adults and rifampin for children.
