Grand rounds

Question 1

• Common every spring virus season
• Vomiting/diarrhea + inadequate PO intake
• Rarely diuretic overdose/overuse
• # 1 worldwide cause of pediatric death

___________ shock

Answer 1

HYPOVOLEMIC shock

Question 2

• Unusual in children outside congenital heart population
• Viral myocarditis
• Heavy metals
• Beta-blockade
• Opiates

___________ shock

Answer 2

CARDIOGENIC shock

Question 3

• MC cause of shock in adults
• Infection leading to inadequate substrate delivery

______ shock

Answer 3

SEPTIC shock

Question 4

T/F: For shock diagnosis, you’ll see metabolic acidosis and elevated lactate.

Answer 4

TRUE

Question 5

T/F: Hypotension (due to shock) is a late and largely premorbid finding in children.

(If your pt is hypotensive, you’re already well behind the game.)

Answer 5

TRUE

Question 6

What dictates preload?

Answer 6

VOLUME

Question 7

What dictates afterload? (3)

Answer 7

• Norepi
• Vasopressin
• Dopamine

Question 8

What dictates contractility? (3)

Answer 8

• Epinephrine
• Dopamine
• Milrinone

Question 9

Describe the RAPID volume resuscitation in a pediatric shock case.

Answer 9

• > 40 mL/kg within first hour and possibly up to 80 mL/kg in first three hours
• No increase in cardiogenic pulmonary edema, ARDS, or cerebral edema
• Reduced mortality

Question 10

Mechanical ventilation will:

• Almost certainly be necessary
• Not be trivial
• Decrease myocardial work

Why? (4)

Answer 10

• Reduces afterload
• Reduces O2 consumption
• Allows high O2 delivery
• Avoids the problem of deterioration en route

Question 11

Expanded antimicrobial coverage is essential, so what Rx?

What would you consider adding for G+ toxic shock?

Answer 11

Vancomycin

Consider adding clindamycin for G+ toxic shock.

Question 12

What is the 50-40-30-20-15 Rule for breathing rate?

Answer 12

Newborns 50 ± 10
Infants 40 ± 10
Toddlers 30 ± 10
Preschoolers/school-age 20 ± 5
Teenagers ("cuz they're different") 15 ± 5

Question 13

Formula to size uncuffed trach tube is:

Answer 13

(Age in years + 4) / 4

Question 14

What is given in an emergency setting for extreme hyperkalemia? (4)

Answer 14

Sodium gluconate
Calcium chloride
Glucose and insulin
Kayexelate

+ stat Renal consult