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Cardiovascular > EXAM #1: CARDIOGENIC SHOCK IN PEDIATRICS > Flashcards

EXAM #1: CARDIOGENIC SHOCK IN PEDIATRICS Flashcards

1
Q

In children, what is the most common etiology of shock?

A

Hypovolemic

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2
Q

What is shock?

A

Inadequate perfusion

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3
Q

What is cardiogenic shock?

A

Failure of the heart as a pump to maintain adequate perfusion

*Far less common than hypovolemic shock and septic shock

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4
Q

What is CO?

A

HR x SV

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5
Q

What are the determinants of SV?

A

Preload
Afterload
Contractility

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6
Q

What is blood pressure?

A

Product of CO and SVR

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7
Q

What do you need to remember about kids and shock?

A

Blood pressure is a poor indication of shock

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8
Q

How do kids compensate for a decrease in CO?

A

Increase in HR before changes in SV

Thus, tachycardia is a very significant sign in children

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9
Q

What are the valuable determinants of CO in a child?

A

1) Capillary refill
2) Peripheral pulses
3) Mentation
4) Urine output
5) Acid-base balance

*****All come before BP

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10
Q

What is the general etiology of cardiogenic shock?

A
  • Increased preload
  • Increased- afterload
  • DECREASED contractility
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11
Q

What is the general etiology of hypovolemic shock?

A
  • DECREASED preload
  • Increased afterlaod
  • Normal contractility
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12
Q

What are the major etiologies of cardiogenic shock in children?

A 
Rheumatic fever 
Cardiomyopathy
Pneumothorax 
Hyperkalemia 
Hypocalcemia 
Congenital heart disease
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13
Q

What are the symptoms of cardiogenic shock in children?

A

Initially vague:

  • Poor feeding
  • Less activity
  • Syncope
  • AMS
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14
Q

What is the principal means of responding to decreased CO in kids?

A

Tachycardia

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15
Q

What studies should you order for a child in cardiogenic shock?

A

ECG
CXR
Echocardiography*

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16
Q

What are lab studies that should be ordered for a child with suspected cardiogenic shock?

A 
Glucose 
Electrolytes 
Ca++ 
Blood gas 
Cardiac enzymes 
Viral titers
17
Q

Practically, how do you manage cardiogenic shock in a child?

A

1) Airway
2) Oxygen
3) Access (IV or IO)

*Sedate for airway management

18
Q

How do you acutely manage cardiogenic shock in a child?

A

1) Boluses of 5-10 mL/kg of isotonic fluids to INCREASE PRELOAD
2) Glucose
3) Maintain temperature
4) Meds

19
Q

In a neonate with cardiogenic shock, what are you concerned about?

A

Ductal dependent lesion

20
Q

How do you treat cardiogenic shock in the neonate with a ductal dependent lesion?

A

PGE1–to MAINTAIN the duct

21
Q

What medications should you consider for a child in cardiogenic shock?

A 
Dopamine 
Dobutamine
Epinephrine
Milrinone 
Nitroprusside
Nitrous oxide
22
Q

What drugs should be AVOIDED in the setting of cardiogenic shock?

A

Phenylephrine

Norepinephrine

23
Q

What can you do for refractory cardiogenic shock?

A

1) Extracorporeal membrane oxygenation

2) Ventricular assist device

Cardiovascular (38 decks)

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