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PALS 2020 > PALS feb 20 part 8- shock > Flashcards

PALS feb 20 part 8- shock Flashcards

1
Q

what are the two types of shock you should be able to differentiate between?

A

compensated and hypotensive

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2
Q

True or false: shock can be present with or without hypotension

A

true

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3
Q

shock that results from inadequate blood volume or oxygen carrying capacity is called

A

hypovolemic shock, including hemorrhagic shock

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4
Q

shock that results from inappropriate distribution of blood volume and flow is called what?

A

distributive shock

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5
Q

shock that results from impaired cardiac contractility is called what?

A

cardiogenic shock

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6
Q

shock that results from obstructed blood flow is called what?

A

obstructive shock

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7
Q

In this clinical condition, there are clinical signs of inadequate tissue perfusion, but the blood pressure is in the normal range.

A

Compensated shock

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8
Q

what are some signs of compensated shock referring to the organs; skin 4, heart 1, pulses 2, kidneys 1, intestines 2, and brain 3

A 
heart - tachycardia
skin - cold, pale, mottled, diaphoretic 
Pulses - weak, narrow pulse pressure 
kidneys - oliguria 
Intestines - vomiting, ileus 
brain - AMS, anxiety/restless, disorientation
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9
Q

another name for hypotensive shock is what

A

decompensated shock

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10
Q

what is the formula to determine is hypotension is present in a child?

A

70 mmHg + (childs age x 2)

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11
Q

how long can it take for compensated shock to progress into decompensated shock

A

it can take a matter of hours

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12
Q

How long can it take for decompensated shock to progress into cardiac arrest?

A

potentially minutes

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13
Q

what are some possible causes of hypovolemic shock?

5

A

gastroenteritis (vomiting), burns, hemorrhage, inadequate fluid intake, osmotic diuresis (DKA)

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14
Q

what are some possible causes of cardiogenic shock

4

A

congenital heart disease, myocarditis, cardiomyopathy, arrhythmia

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15
Q

what are some possible causes of distributive shock?

3

A

sepsis, anaphylaxis, spinal cord injury

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16
Q

what are some possible causes of Obstructive shock?

4

A

tension pneumothorax, cardiac tamponade, pulmonary embolism, constriction of the ductus arteriosus

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17
Q

______ shock refers to the clinical state of characterized by reduced SVR leading to _______ of blood volume and blood flow, such as with septic, anaphylactic, and neurogenic shock

A

distributive shock

maldistribution

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18
Q

what are three different types of distributive shock?

A

septic shock
anaphylactic shock
neurogenic shock

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19
Q

the most common type of of distributive shock is

A

septic shock

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20
Q

neurogenic shock is also known as _____ shock

A

spinal

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21
Q

what are the three primary signs of neurogenic shock

A

hypotension with a wide pulse pressure
normal heart rate or bradycardia
hypothermia

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22
Q

this type of shock is the result of abnormal cardiac function or pump failure

A

cardiogenic shock

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23
Q

_____ shock refers to conditions that physically impair blood flow by limiting venous return to the heart or limit the pumping of blood from the heart

A

obstructive shock

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24
Q

what are 4 common causes in pediatrics that can cause obstructive shock?

A

pericardial tamponade
tension pneumothorax
ductal-dependent congenital heart defects
massive pulmonary embolism

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25
Q

name 5 goals in the treatment of shock

A 
Improve O2 delivery
Balance tissue perfusion and metabolic demand 
reverse perfusion abnormalities 
support organ function 
prevent progression into cardiac arrest
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26
Q

warning signs that indicate progression from compensated shock to hypotensive shock include (4)

A

narrowing pulse pressure
hypotension
decreasing LOC
weakening central pulses

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27
Q

name 4 things that can result in hyperkalemia

A

renal dysfunction
cell death
excess potassium administration
acidosis

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28
Q

How does acidosis cause hyperkalemia?

A

acidosis causes a shift in potassium from the intracellular to the extracellular space, including the intravascular.

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29
Q

_____ _____ develops from the production of acids, such as lactic acid, when tissue perfusion is inadequate

A

metabolic acidosis

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30
Q

how does sodium bicarb help resolve acidosis

A

works as a buffer by combining with hydrogen ions to produce CO2 and water

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31
Q

In general, isotonic crystalloid should be given in a __ml/kg bolus over __ to __ minutes, unless you suspect _____ shock

A

20 ml/kg over 5 to 20 minutes

cardiogenic

32
Q

In cardiogenic shock, fluid resuscitation consists of __ to __ ml/kg given over __ to __ minutes

A

5 to 10 ml/kg over 10 to 20 minutes

33
Q

the expected urine output for infants and young children is about __ to __ ml/kg per hour

A

1.5 to 2

34
Q

what do inotropes do?

A

increase cardiac contractility and heart rate

35
Q

dopamine, epinephrine, and dobutamine are all what

A

inotropes

36
Q

What is a phosphodiesterase inhibitor?

Give one example

A

Decreases SVR
Improves coronary artery blood flow
improves contractility
ex. Milrinone

37
Q

give two examples of a vasodilator

A

nitroglycerin

Nitroprusside

38
Q

Blood and blood products are generally not used for volume expansion in children with shock unless shock is due to what

A

hemorrhage

39
Q

for children that have been poisoned, such as have ingested calcium channel blockers, give fluid resuscitation of __-__ ml/kg over __-__ minutes

A

5-10 ml/kg over 10-20 minutes

40
Q

a pediatric patient in DKA should recieve fluid resuscitation at the rate of __-__ ml/kg over what amount of time?

A

10 - 20

over a matter of time governed by local protocol, if used give over at least 1 - 2 hours

41
Q

hypoglycemia in preterm neonates and term neonates is defined as a blood sugar below what

A

45

42
Q

For the purposes of the PALS Provider course, shock is categorized into 4 types, what are they?

A

hypovolemic
distributive
cardiogenic
obstructive

43
Q

clinically significant dehydration in children is generally associated with at least __% volume depletion, corresponding with a fluid deficit of __ ml/kg or greater

A

5

50

44
Q

shock may be observed in children with fluid deficits of __ to __ ml/kg, but is more consistently observed with deficits of __ ml/kg or greater

A

50 to 100

100

45
Q

failure to improve after 3 boluses of 20 ml/kg may indicate what?
(4)

A

the extent of fluid losses may be underestimated
they type of fluid being used may need to be altered ie colloid or blood
there are ongoing fluid losses ie occult bleeding
Your initial assumption about the etiology of the shock may be incorrect.

46
Q

In children, the dividing line between mild and compensated vs moderate to severe hypotensive hemorrhagic shock is thought to correlate with an acute loss of about __% of blood volume.

A

30

47
Q

The estimated total blood volume of a child is about __ to __ ml/kg.

A

75 - 80

48
Q

For fluid resuscitation in hemorrhagic shock, give about __ ml of isotonic crystalloid for every __ ml of blood lost

A

3
1
known as the 3 to 1 rule

49
Q

name three types of distributive shock

A

septic
anaphylactic
Neurogenic

50
Q

what is the difference between primary and secondary bradycardia?

A

primary bradycardia is caused by congenital or acquired heart conditions, cardiomyopathy, and myocarditis

51
Q

what are some causes of secondary bradycardia?

5

A 
hypoxia 
acidosis
hypotension
hypothermia 
drug effects
52
Q

what is the dose per IV/IO for epinephrine?

what is the dose per ET tube?

A

0.01 mg/kg per IV/IO

ET tube 0.1 mg/kg

53
Q

what is the dose for atropine via the IV/IO route

A

0.02 mg/kg; minimum 0.1 mg, maximum 0.5 mg

may repeat dose once, five minutes after the first

54
Q

what is the dose for atropine via the ET tube route

A

0.04 to 0.06 mg/kg

55
Q

for infants in SVT in need of a vagal maneuver, what is the preferred method?

A

ice bag to the face

older children who can cooperate may blow through a straw

56
Q

what is the drug of choice for the treatment of SVT?

what is the dose?

A

adenosine

0.1 mg/kg, max initial dose 6 mg as rapid IV bolus

57
Q

if the first dose of adenosine is effective, the rhythm will convert within __ to __ seconds. If not, what is the second dose?

A

15 to 30

0.2 mg/kg, max 2nd dose is 12 mg

58
Q

what is a common cause of adenosine failure?

A

not pushed fast enough or not with an adequate fluid bolus

59
Q

ABG values

what is the normal range for pH

A

7.35 - 7.45

60
Q

ABG values

what is the normal range for PO2

A

80 - 100 mmHg

61
Q

ABG values

what is the normal range for PCO2

A

35 - 45 mmHg

62
Q

ABG values

what is the normal range for HCO3 (bicarb)

A

22 - 28 mEq/L

63
Q

what are the 4 ABG lab values?

A

O2
PCO2
pH
bicarb HCO3

64
Q

what is a way to relieve gastric inflation post ROSC?

A

insert a G tube

65
Q

what is the DOPE mnemonic?

A

sudden deterioration of the intubated patient
Displacement of the tube; may be out of the trachea and into the right or left bronchus
Obstruction of the tube
Pneumothorax; stated as above, look for midline trachea
Equipment failure

66
Q

give 3 reasons during post ROSC that you should use a neuromuscular block

A

1 high peak or mean airway pressure caused by high airway resistance or reduced lung compliance
2 patient / ventilator asynchrony
3 difficult airway

67
Q

when using a neuromuscular block, what are 3 things you should keep in mind that the block can mask or doesn’t do

A

the block can mask seizures, and does not provide pain relief or sedation

68
Q

When using a neuromuscular block on a child with an ET tube, what are 5 things you should look for signs of?
Why?

A

look for signs of stress, tachycardia, hypertension, pupil dilation, and tearing.
Neuromuscular blocks do not provide analgesia or sedation.

69
Q

If a child has an elevated anion gap but a normal lactate, what should you look for?

A

other causes of acidosis, such as toxins or uremia

70
Q

what is the lab value used to monitor metabolic acidosis?

A

lactic acid, anion gap

71
Q

what does SVR stand for?

A

Systemic Vascular Resistance

pg 289

72
Q

what are three drugs to consider after a child remains hypotensive after a fluid bolus administration?

A

Epinephrine
Dopamine
Norepinephrine

73
Q

what is the drip rate for a hypotensive child treated with epinephrine?

A

0.1 - 1 mcg/kg per minute

74
Q

what is the drip rate for a hypotensive child treated with Dopamine?

A

10 - 20 mcg/kg per minute

75
Q

what is the drip rate for a hypotensive child treated with Norepinephrine?

A

0.1 - 2 mcg/kg per minute

76
Q

If a child is normotensive and remains poorly perfused after bolus administration, name 5 drugs you may consider.

A 
Dobutamine
Dopamine
Low dose epinephrine 
Milrinone
inamrinone

PALS 2020 (3 decks)

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