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PALS > Lesson 3: Shock > Flashcards

Lesson 3: Shock Flashcards

1
Q

What should be done if you notice a petechial rash and/or purpura during the rapid assessment?

A

Isolate the patient and wear appropriate PPE (may indicate sepsis)

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2
Q

What is a lab test to help determine whether perfusion and oxygen delivery are sufficient or not?

A

Lactate levels

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3
Q

What is the progression of shock?

A

Compensated
Decompensated
Cardiopulmonary failure
Cardiac arrest

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4
Q

What are the 4 types of shock?

A

Hypovolemic
Distributive
Cardiogenic
Obstructive

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5
Q

What is the most common form of shock in children?

A

Hypovolemic

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6
Q

What is the primary mechanism of impaired oxygen delivery in hypovolemic shock?

A

Reduced CO resulting from decreased preload and stroke volume.

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7
Q

What are 4 potential causes of hypovolemic shock?

A

Decreased fluid intake
Fluid losses
Translocation of intravascular fluid
Blood loss

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8
Q

What is a late and ominous sign of hypovolemic shock?

A

Hypotension

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9
Q

What happens in distributive shock?

A

There is an abnormal distribution of the intravascular volume resulting from inappropriate vasodilation.

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10
Q

What are 3 types of distributive shock?

A

Septic
Anaphylactic
Neurogenic

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11
Q

What is sepsis?

A

A systemic response to a known or suspected infection.

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12
Q

What are signs and symptoms of sepsis?

A

Tachycardia
Tachypnea
High/low body temperature
High/low WBC count

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13
Q

What are common manifestations of organ dysfunction in septic shock?

A

Decreased cardiac function
AMS
Acute lung injury
Kidney or liver dysfunction
Impaired coagulation

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14
Q

What causes neurogenic shock?

A

Disruption of the sympathetic pathways within the spinal cord.

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15
Q

What is a classic sign of neurogenic shock?

A

Relative bradycardia (hypotension in the absence of tachycardia)

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16
Q

What is the central physiologic abnormality in cardiogenic shock?

A

Decreased CO

17
Q

What are some causes of cardiogenic shock?

A

Myocarditis
Cardiomyopathy
Congenital heart disease
Arrhythmias

18
Q

How do conditions cause obstructive shock?

A

Impede cardiac outflow
Impede return of blood to the heart

19
Q

What are some causes of obstructive shock?

A

Cardiac tamponade
Tension pneumothorax
Pulmonary embolism
Congenital heart defects

20
Q

What is the cornerstone of therapy in shock?

A

Early fluid resuscitation

21
Q

How should fluids be administered for hypovolemia?

A

20 mL/kg IV/IO 0.9% NS or LR

22
Q

What should be considered after the first fluid bolus if inadequate perfusion persists in hemorrhagic hypovolemic shock?

A

PRBCs
Whole blood
TXA

23
Q

How much fluids may be required in the first 15-30 minutes of resuscitation in septic shock?

A

60 mL/kg

24
Q

What size fluid bolus is recommended in patients with cardiogenic shock?

A

5-10 mL/kg over 10-20 minutes

25
Q

What are signs and symptoms of hypervolemia?

A

Hepatomegaly
Crackles

26
Q

What size fluid bolus should be given to a neonate?

A

10 mL/kg

27
Q

What is the cornerstone of therapy for hemorrhagic shock?

A

Replacement with blood

28
Q

How much PRBCs or whole blood should the child with hemorrhagic shock receive?

A

PRBCs 10 mL/kg
Whole blood 10-20 mL/kg

29
Q

What electrolyte abnormalities may occur following a massive transfusion?

A

Hypocalcemia (anticoagulant citrate binds with calcium)
Hyperkalemia (especially if stored for more than one week)

30
Q

Drugs that act on the following receptors cause what effect?

Alpha
Beta 1
Beta 2

A

Alpha: vasoconstriction
Beta 1: increase cardiac contractility (inotropy) and heart rate (chronotropy)
Beta 2: vasodilation

31
Q

What are the main vasopressors used in PALS?

A

Epinephrine & Norepinephrine

Phenylephrine used to a lesser extent

32
Q

What are inotropic agents used to increase cardiac contractility and heart rate?

A

Epinephrine
Dopamine
Dobutamine

33
Q

What is an example of a vasodilator used to reduce afterload?

A

Nitroprusside

34
Q

Why would Prostaglandin E1 be administered to an infant?

A

To prevent the ductus arteriosus from closing or to restore ductal patency

35
Q

What RSI medication should be avoided when intubating a patient with septic shock?

A

Etomidate

36
Q

What pharmacological therapy is the first line therapy in cardiogenic shock?

A

Milrinone

PALS (5 decks)

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