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Pathopharm Final > Module 10: Peds Shock & Burns - Part 4: 87-115 > Flashcards

Module 10: Peds Shock & Burns - Part 4: 87-115 Flashcards

1
Q

What is Obstructive shock?

A

Is inadequate cardiac output caused by an impediment to blood flow to or from the heart into the pulmonary or systemic circulation.

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2
Q

What happens with Ductal-dependent pulmonary blood flow? What is it a clinical manifestation of?

A

Hypoxemia will become profound when the ductus arteriosus begins to constrict.
Obstructive shock

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3
Q

What occurs with ductal-dependent systemic blood flow? What is it a clinical manifestation of?

A

Systemic pulses will become faint or absent; extremities will become cold and pale.
Signs of pulmonary venous congestion will develop when the ductus arteriosus begins to close.
Obstructive shock

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4
Q

signs of ___ will develop when the ductus arteriosus begins to close.

A

pulmonary venous congestion

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5
Q

_____ will become profound when the ductus arteriosus begins to constrict.

A

Hypoxemia

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6
Q

What are the clinical manifestations of obstructive shock?

A

Ductal-dependent pulmonary blood flow
Hypoxemia will become profound when the ductus arteriosus begins to constrict.
Ductal-dependent systemic blood flow
Systemic pulses will become faint or absent; extremities will become cold and pale.
Signs of pulmonary venous congestion will develop when the ductus arteriosus begins to close.
Tension pneumothorax
cardiac tamponade
pulmonary embolus

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7
Q

What are the S/S of tension pneumothorax?

A

Decreased breath sounds and chest expansion on the side of the pneumothorax
Shift of the mediastinum to the contralateral chest
Significant hypoxemia

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8
Q

What are the s/s of cardiac tamponade?

A

Systemic or pulmonary edema, or both, with low cardiac output

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9
Q

What are the s/s of PE?

A

Hypoxemia, severe respiratory distress (or shortness of breath), and signs of right ventricular failure

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10
Q

How would you treat obstructive shock?

A

Establish and maintain an adequate airway.
Establish vascular access.
Administer fluid bolus of 10 to 20 ml/kg of isotonic crystalloid; repeat if effective.
Administer prostaglandin E1 to reopen a constricted ductus arteriosus.
Perform cardiac catheterization for other defects.
Perform needle decompression for tension pneumothorax or cardiac tamponade.
Provide fibrinolytic and anticoagulation therapy (possible embolectomy) for pulmonary embolus.

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11
Q

What kind of fluid bolus should you administer in the treatment of obstructive shock?

A

Administer fluid bolus of 10 to 20 ml/kg of isotonic crystalloid; repeat if effective.

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12
Q

What should you administer for obstructive shock top reopen a constricted ductus arteriosus?

A

prostaglandin E1

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13
Q

What is the generalized treatment for shock?

A

Provide adequate oxygen delivery.
Humidified supplementary oxygen
Monitor glucose and electrolyte levels and temperature.
Transfuse blood components, if needed.
Administer IV fluids (volume resuscitation).
Crystalloids and colloids; no hypotonic fluids
Monitor urine output and urine-specific gravity.
Monitor blood and central venous pressures.

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14
Q

Should you give hypotonic solutions for the tx of shock?

A

NO

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15
Q

What 2 vaccines are a part of the emerging therapies for shock and sepsis?

A

Haemophilus influenzae and Neisseria meningitidis vaccines

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16
Q

What are the 2 resuscitation techniques that are a part of the emerging therapies for shock and sepsis?

A

Targeting high, rather than normal, cardiac output
Oxygen delivery during resuscitation

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17
Q

Why is staged repair of significant injuries a part of the emerginging therapies for shock and sepsis?

A

to avoid immunologic and coagulation issues of transfusion or blood products.

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18
Q

What is a reperfusion injury?

A

Is cellular damage caused by restoration and reperfusion of oxygen to cells that have been exposed to reversible hypoxic conditions.

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19
Q

What kind of responses does a reperfusion injury trigger?

A

a proinflammatory and procoagulant response

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20
Q

A reperfusion injury can lead to ____.

A

MODS

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21
Q

A reperfusion injury occurs from the generation of _____

A

highly reactive oxygen intermediates.

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22
Q

What kind of damaging effects do oxygen intermediates have? (3)

A

damage cell membranes, denature proteins, and disrupt chromosomes.

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23
Q

The amount of free oxygen radical production depends on what?

A

the severity and duration of the ischemic period.

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24
Q

Burns are a common result of: (4)

A

inadequate supervision, curiosity, inability to escape the burning agent, or intentional abuse.

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25
Q

Scalded injuries are most common in (younger/older)?

A

young children

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26
Q

Flame injuries are most common in (younger/older) children

A

older

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27
Q

10% of child burn injuries is from ____

A

child abuse

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28
Q

What kinds of burns suggest child abuse?

A

Pattern burns, forced emersion burns, splash or spill burns inappropriate for age, cigarette burns

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29
Q

scalded injuries are the result of: (3)

A

Hot water, grease, other hot liquids

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30
Q

Contact burns occur from _____

A

actual touching

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31
Q

Flame injuries in younger children are mostly from: (2)

A

lighters and matches

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32
Q

Flame injuries in older children are mostly from: (1)

A

gasoline

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33
Q

electrical burns are the result of ____ or ____

A

High- or low-voltage current

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34
Q

What kind of burns result from swallowing caustic agents?

A

chemical

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35
Q

The rule of nines is (accurate/inaccurate) in children

A

inaccurate

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36
Q

Why is the rule of nines not accurate in children? What is the same between children and adults? what is differnet?

A

Arms and trunk demonstrate the same proportions as an adult
Head and neck: 18%
Each lower extremity: 4%

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37
Q

What is the modified rule of nines?

A

Modification deducts 1% from the head and adds 0.5% to each leg for each year of life after 2 years of age.

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38
Q

Is an infant more or less likely to sustain a deeper burn? Why?

A

Infant skin is extremely fragile and more likely to sustain a deeper burn.

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39
Q

Very young children are intolerant of rapid fluid shifts. Why is this?

A

immature renal function negatively affects their ability to retain sodium and water.

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40
Q

Why are children at an increased risk for infection and sepsis?

A

Have not achieved maturity of the immune system

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41
Q

Children younger than_______ have a significantly higher risk for associated morbidity and mortality when it comes to burns

A

2 years old

42
Q

What 3 factors determine the severity of the burn injury?

A

age
areas of the body burned
secondary injuries and manifestations

43
Q

What are 2 potentional secondary injuries and manifestations from burns?

A

bleeding and fractures

44
Q

What effects are immediately seen from loss of substantial areas of skin a/w burns in children?

A

Direct and evaporative fluid losses are immediately seen

45
Q

T/F significant edema only occurs in the areas of the burn injury for children

A

FALSE
Significant edema can result not only in the area of injury but also in unburned areas.

46
Q

What happens to the CO in children immediately after burn injruy?

A

Significant reduction in cardiac output occurs immediately after injury.

47
Q

Systemic vascular resistance is initially (increased/decreased) with burn injuries for children

A

INCREASED

48
Q

(Younger/Older) children are more susceptible to increased intraabdominal pressure with burn injuries

A

younger

49
Q

What kind of range of pulmonary clinical manifestations would you see with burn injuries in children?

A

Clinical manifestations range from inhalation injury, pulmonary edema, and respiratory failure to aspiration and pneumonia.

50
Q

Small degree of edema results in greatly increased work of breathing in the child. T/F

A

TRUE

51
Q

Why do you see more rapid desaturation in children compared to adults with burn injuries?

A

Fatigue, related to the increased work of breathing, results in more rapid desaturation than in adults.

52
Q

What can happen in children in the presnece of partial obstruction? Why?

A

Soft cartilage of the pediatric airway is prone to collapse in the presence of partial obstruction.

53
Q

What causes constriction of the chest and impairment of respiratory excursion in the very young child?

A

Increased pliability of the rib cage

54
Q

In burn shock you have hypovolemia and the (intra/extra) cellular Na+ is depleted

A

extracellular

55
Q

What is the most accurate parameter of the adequacy of fluid resuscitation?

A

urine output

56
Q

Urine output of 1 ml/kg/hr in children weighing less than _____ kg: Suggested endpoints

A

30

57
Q

T/F Children require fluid resuscitation for smaller burns than do adults.

A

TRUE

58
Q

What results in increased evaporative water losses and proportionately more fluid during resuscitation fro children?

A

Child’s relatively greater ratio of body surface area to weight

59
Q

____ is a late sign of burn shock in children.

A

hypotension

60
Q

________ is performed when venous access techniques fail, especially for children younger than 5 years of age.

A

Intraosseous cannulation

61
Q

Fluid resuscitation is generally required for children after thermal injuries in excess of ___% to ___15% of their TBSA.
What formula should be used?

A

10-15
Use modified Parkland formula.

62
Q

Approximately ____ hours after burn injury in children, edema fluid begins to mobilize and output increases.

A

36

63
Q

What GI manifestation often occurs after a major burn injury in children?

A

paralytic ileus

64
Q

Depending on the burn size, atrophy of the gastrointestinal tract mucosa can occur, immediately leading to ____ and ultimately ____

A

increased bacterial translocation and, ultimately, to sepsis.

65
Q

What are the GI changes that occur with a burn injury in children?

A

Mucosal atrophy occurs, digestive absorption changes, and intestinal permeability increases.

66
Q

(Young/Older) children are at increased risk for microbial invasion caused by ___ and ______

A

young
an immature immune system and limited antibody production.

67
Q

How do cytokines increase inflammation for burn injuries in children?

A

by enhancing catabolism and hypermetabolism.
Proinflammatory function of cytokines enhances protection from sepsis, whereas the antiinflammatory function supports anabolism (tissue repair).

68
Q

(Pro/Anti) inflammatory function of cytokines enhances protection from sepsis

A

PRO

69
Q

(pro/anti) inflammatory function of cytokines supports anabolism (tissue repair)

A

ANTI

70
Q

____ and _____ become the primary complication of burn injuries in children during healing

A

Local and systemic infections

71
Q

___ and ____ present the most immediate threat after burn trauma in children.

A

Shock and pulmonary compromise

72
Q

Children are ______ for many weeks after burn injury.

A

immunosuppressed

73
Q

_______ decreases the frequency and duration of septic episodes caused by burn wound flora in children.

A

Meticulous wound care

74
Q

How are glycogen stores different in children? Why is this relevant to burn injuries?

A

Glycogen stores for meeting the increased energy demands of the burn are limited in children.

75
Q

What metabolic process is accelerated for children with burn injuries?

A

Initiation of protein and lipid catabolism for glycogenesis is accelerated.

76
Q

Prolonged metabolic dysfunction for children with burn injuries may lead to ___ and ____

A

loss of lean body mass and increased morbidity.

77
Q

What is the Ebb Phase of burn injuries in children? When does it occur? What are the clinical manifestations?

A

Initial: Occurring during the immediate postburn period; continuing for 3 to 5 days
Reduced oxygen consumption, impaired circulation, and cellular shock

78
Q

What is the catabolic (flow) phase of burn injuries in children? When does it occur? What are the clinical manifestations?

A

After the resolution of the shock and the restoration of circulating volume
Hypermetabolism with increased oxygen consumption and elevation of catecholamines, glucocorticoids, and glucagon

79
Q

What 4 things are increased/elevated in the Catabolic (flow) phase of burn injuries for children?

A

increased oxygen consumption and elevation of catecholamines, glucocorticoids, and glucagon

80
Q

Hypermetabolism results in a rapid turnover of ___ and ____, which are important in wound healing and to the immune response.

A

vitamins and trace minerals

81
Q

How much protein a day is needed for children with burn injuries?

A

Up to 2.5 to 4 g protein/kg/day

82
Q

Infants are at increased risk for a precipitous drop in core body temperature caused by ______.

A

an inability to regulate heat loss by shivering.

83
Q

Why are infants and children especially vulnerable to preciptous drops in core body temperature with burn injuries?

A

because of the large surface area relative to metabolically active tissue.

84
Q

Children with burns in excess of ____% of TBSA often require supplementation with tube feeding.

A

20

85
Q

What 2 things are given to children to improve muscle protein metabolism through enhanced protein synthesis efficiency?

A

Anabolic steroid agents, along with nutritional support

86
Q

Deep dermal or full-thickness burn injuries are _______ as soon as the child is hemodynamically stable.

A

surgically excised

87
Q

What are the 2 different grafts used for burn wound management in children? When would you use each?

A

Split-thickness sheet grafts are used unless the burn area is large; mesh grafts are then used.

88
Q

Scar maturation may take up to ___ for children after burn injuries.

A

2 years

89
Q

Functional limitation may develop from scar maturation following burn injuries as the child grows, particularly over joints. T/F

A

TRUE

90
Q

_______ Is necessary to restore anatomic integrity and promote independent function r/t scar maturation following burn injuries in children.

A

Reconstructive surgery

91
Q

Pain management is a significant challenge in the pediatric population. T/F

A

TRUE

92
Q

What 2 types of pain are present without activity for children follwoing a burn injury?

A

Procedural pain and background pain

93
Q

Pain perception is affected by what in children?

A

the degree of emotional overlay or affective experience.

94
Q

Measurement of pain is particularly challenging in which pediatric age group? What can you use for this population?

A

young infants, who lack the language skills to express pain.
Variety of tools are available, from physiologic monitors to behavioral analyses and analog scales.

95
Q

Burn units are established for providing chronic care T/F

A

FALSE
acute NOT chronic

96
Q

When does rehab become the major focus following a burn injury in children? How long should rehab continue?

A

Is the major focus once the wound is covered and continues until all reconstructive procedures have been completed.
May extend over many years in the pediatric population.

97
Q

Why do children require specialized management to ensure optimal functional and cosmetic results follwoing burn injuries?

A

Scar and contracture management are necessary for prolonged periods because of changes in body composition as the child grows and matures

98
Q

Why do very young children present unique challenges during the recovery period of burn injuries?

A

Small body size is difficult to fit with pressure garments and splints; growth is rapid, and cooperation limited.

99
Q

What type of injury is the cause of most deaths during the recovery period of children with burn injuries?

A

inhalational injruy

100
Q

Children need PT, OT, and psychosocial support follwoing a burn injury T/F

A

TRUE

Pathopharm Final (8 decks)

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