CLIPP 23 Flashcards
determining severity of illness should take into account these two things
if pt is perfusing major organs and if pt has underlying issues that place them at risk
irritable, lethargic
two words we commonly use in daily language that don’t seem so bad but have bad connotations in medical jargon
4 conditions–>AMS that must be quickly reversed to prevent cellular damage
shock (septic, hypovol, or cardiac), hypoxemia, hypoglycemia, poisoning
conditions leading to shock/acidossis can lead to AMS and include
DKA, renal failure, intussception, sepsis. also consider CNS pathology
always start w the ___ in an exam
CAB and VS
poor test of circulatory well being
checking if extremities are warm (BP also a poorish indicator bc body’s protective mech maintain it, not bodys circulation)
key measure of vol statsu
heart rate - listen to heart, take a periph or central pulse
how to assess breathign
listen to lungs, identify WOB and rate, pulse oxy
if no air movement, you should
open the airway - jaw thrust or by positioning the neck (higher age = more hyperextension)
lethargy + pinpoint pupils
opioid ingestion
to determine if someone is in shock, look for
signs of decreased perfusion? like incr cap refill, tachycarida, poor pulses
definition of shock
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 aerobic oxygen production.
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.
shock in pediatrics
hypotension is a LATE sign of shock in kids due to their excellent compensatory mechanisms such as tachycardia, vasoconstriction, increased contractility, tachypnea and increased venous tone
hypotension in pediatrics in terms of shock
LATE sign of shock!
most common causes of shock in kids
hypovol (hemorrhagic , dehyd, diarrhea) or septic
4 key categories of shock and their definitions
distributive (neurogenic, anaphylactic) -intravascular hypovolemia
hypovolemic - most common, occurs due to not enough fluid intake to compensate for fluid output
cardiogenic-rare in kids
septic-toxins affect fluid distrib and CO and often can present as warm/compensated shock
shock characterized by Warm extremities Bounding pulses Tachycardia Tachypnea Adequate urination Mild metabolic acidosis
septic
shock characterized by Cool extremities Delayed capillary refill (> 2 seconds) Hypotension Tachypnea Increasing obtundation Decreased urine output
cardiogenic
shock characterized by Mental status changes Tachypnea Tachycardia Hypotension Cool extremities Oliguria
hypovolemic
shock characterized by third space losses, increased cap. permeability, and vasodil
distributive (neurogenic, anaphylactic)
priority tx in shock
intravascular volume replacement (even in situations in which increased volume could be contraindicated such as meningitis which can –> ICP increase. first you stabilize then w/ more volume replacent and then you can fluid restrict when pt no longer n shock
what type of fluid to give in shock
isotonic solutions ie NS, @ a rate as fast as possible, often sepsis pts will need repeated boluses and then give inotropes+vasoconstrictors
if PIV cannot be placed in 90s/3 attempts, use ___
intraosseous line often in prix tin or dotal femur in kids(Central venous line has more risks)
presentation with fever and petchiae - must always consider
meningococcal sepsis
