Lesson 3: Shock Flashcards
What should be done if you notice a petechial rash and/or purpura during the rapid assessment?
Isolate the patient and wear appropriate PPE (may indicate sepsis)
What is a lab test to help determine whether perfusion and oxygen delivery are sufficient or not?
Lactate levels
What is the progression of shock?
Compensated
Decompensated
Cardiopulmonary failure
Cardiac arrest
What are the 4 types of shock?
Hypovolemic
Distributive
Cardiogenic
Obstructive
What is the most common form of shock in children?
Hypovolemic
What is the primary mechanism of impaired oxygen delivery in hypovolemic shock?
Reduced CO resulting from decreased preload and stroke volume.
What are 4 potential causes of hypovolemic shock?
Decreased fluid intake
Fluid losses
Translocation of intravascular fluid
Blood loss
What is a late and ominous sign of hypovolemic shock?
Hypotension
What happens in distributive shock?
There is an abnormal distribution of the intravascular volume resulting from inappropriate vasodilation.
What are 3 types of distributive shock?
Septic
Anaphylactic
Neurogenic
What is sepsis?
A systemic response to a known or suspected infection.
What are signs and symptoms of sepsis?
Tachycardia
Tachypnea
High/low body temperature
High/low WBC count
What are common manifestations of organ dysfunction in septic shock?
Decreased cardiac function
AMS
Acute lung injury
Kidney or liver dysfunction
Impaired coagulation
What causes neurogenic shock?
Disruption of the sympathetic pathways within the spinal cord.
What is a classic sign of neurogenic shock?
Relative bradycardia (hypotension in the absence of tachycardia)
What is the central physiologic abnormality in cardiogenic shock?
Decreased CO
What are some causes of cardiogenic shock?
Myocarditis
Cardiomyopathy
Congenital heart disease
Arrhythmias
How do conditions cause obstructive shock?
Impede cardiac outflow
Impede return of blood to the heart
What are some causes of obstructive shock?
Cardiac tamponade
Tension pneumothorax
Pulmonary embolism
Congenital heart defects
What is the cornerstone of therapy in shock?
Early fluid resuscitation
How should fluids be administered for hypovolemia?
20 mL/kg IV/IO 0.9% NS or LR
What should be considered after the first fluid bolus if inadequate perfusion persists in hemorrhagic hypovolemic shock?
PRBCs
Whole blood
TXA
How much fluids may be required in the first 15-30 minutes of resuscitation in septic shock?
60 mL/kg
What size fluid bolus is recommended in patients with cardiogenic shock?
5-10 mL/kg over 10-20 minutes
What are signs and symptoms of hypervolemia?
Hepatomegaly
Crackles
What size fluid bolus should be given to a neonate?
10 mL/kg
What is the cornerstone of therapy for hemorrhagic shock?
Replacement with blood
How much PRBCs or whole blood should the child with hemorrhagic shock receive?
PRBCs 10 mL/kg
Whole blood 10-20 mL/kg
What electrolyte abnormalities may occur following a massive transfusion?
Hypocalcemia (anticoagulant citrate binds with calcium)
Hyperkalemia (especially if stored for more than one week)
Drugs that act on the following receptors cause what effect?
Alpha
Beta 1
Beta 2
Alpha: vasoconstriction
Beta 1: increase cardiac contractility (inotropy) and heart rate (chronotropy)
Beta 2: vasodilation
What are the main vasopressors used in PALS?
Epinephrine & Norepinephrine
Phenylephrine used to a lesser extent
What are inotropic agents used to increase cardiac contractility and heart rate?
Epinephrine
Dopamine
Dobutamine
What is an example of a vasodilator used to reduce afterload?
Nitroprusside
Why would Prostaglandin E1 be administered to an infant?
To prevent the ductus arteriosus from closing or to restore ductal patency
What RSI medication should be avoided when intubating a patient with septic shock?
Etomidate
What pharmacological therapy is the first line therapy in cardiogenic shock?
Milrinone
