EXAM #1: CARDIOGENIC SHOCK IN PEDIATRICS Flashcards
In children, what is the most common etiology of shock?
Hypovolemic
What is shock?
Inadequate perfusion
What is cardiogenic shock?
Failure of the heart as a pump to maintain adequate perfusion
*Far less common than hypovolemic shock and septic shock
What is CO?
HR x SV
What are the determinants of SV?
Preload
Afterload
Contractility
What is blood pressure?
Product of CO and SVR
What do you need to remember about kids and shock?
Blood pressure is a poor indication of shock
How do kids compensate for a decrease in CO?
Increase in HR before changes in SV
Thus, tachycardia is a very significant sign in children
What are the valuable determinants of CO in a child?
1) Capillary refill
2) Peripheral pulses
3) Mentation
4) Urine output
5) Acid-base balance
*****All come before BP
What is the general etiology of cardiogenic shock?
- Increased preload
- Increased- afterload
- DECREASED contractility
What is the general etiology of hypovolemic shock?
- DECREASED preload
- Increased afterlaod
- Normal contractility
What are the major etiologies of cardiogenic shock in children?
Rheumatic fever Cardiomyopathy Pneumothorax Hyperkalemia Hypocalcemia Congenital heart disease
What are the symptoms of cardiogenic shock in children?
Initially vague:
- Poor feeding
- Less activity
- Syncope
- AMS
What is the principal means of responding to decreased CO in kids?
Tachycardia
What studies should you order for a child in cardiogenic shock?
ECG
CXR
Echocardiography*
What are lab studies that should be ordered for a child with suspected cardiogenic shock?
Glucose Electrolytes Ca++ Blood gas Cardiac enzymes Viral titers
Practically, how do you manage cardiogenic shock in a child?
1) Airway
2) Oxygen
3) Access (IV or IO)
*Sedate for airway management
How do you acutely manage cardiogenic shock in a child?
1) Boluses of 5-10 mL/kg of isotonic fluids to INCREASE PRELOAD
2) Glucose
3) Maintain temperature
4) Meds
In a neonate with cardiogenic shock, what are you concerned about?
Ductal dependent lesion
How do you treat cardiogenic shock in the neonate with a ductal dependent lesion?
PGE1–to MAINTAIN the duct
What medications should you consider for a child in cardiogenic shock?
Dopamine Dobutamine Epinephrine Milrinone Nitroprusside Nitrous oxide
What drugs should be AVOIDED in the setting of cardiogenic shock?
Phenylephrine
Norepinephrine
What can you do for refractory cardiogenic shock?
1) Extracorporeal membrane oxygenation
2) Ventricular assist device
