Pedatric Cardiology & Shock Flashcards
Bradycardia
Most often occurs secondary to hypoxia
Treatment: a/w, O2
Other causes include congenital HB, beta blocker OD, calcium channel blockers OD, Digoxin OD
What can increased ICP cause
Bradycardia, should be suspected in children with:
-ventricular shunts
-Hx of head injury
-suspected child abuse
When do we begin compression
If the pulse is less than 60
SVT with adequate perfusion
-doesn’t vary with activity
Heart rate >220 in infants and >180 in children
-consider adenosine
SVT with poor perfusion
Vaal maneuvers (no delay)
Adenosine
Cardioversion
Wide complex tachycardia with adequate perfusion
-ALS
Amiodarone
Cardioversion
Wide complex tachycardia with poor perfusion
Cardioversion
Pharmacological intervention
Infant chest compressions
2 fingers just below intermammary line
2 thumbs encircling technique
100-120 compressions per min
Best sign of effective ventilation
Chest rise
Best sign of effective circulation
Output with each compression
What percent O2
100%, there is no risk in using 100% short term
Fluid resuscitation
20cc/kg
What is shock
The abnormal condition in which inadequate oxygen and metabolic substrates fail to meet the demands of the tissue
What is compensated shock
Tissue perfusion maintained and blood pressure preserved
Decompensated shock
-hypotensive
-unable to maintain organ perfusion
Signs of compensated shock
-tachycardia
-cool, pale, diaphoretic skin
-delayed cap refill
-weak peripheral pulses/narrow pulse pressure
-vomiting
A child can be in severe shock and still maintain what
B/P
Hypotension is a sign of?
Irreversible organ injury and impending arrest
Hypovolemic shock causes
Most common cause of shock in children
-diarrhea
-Hemorrhage
-Vomiting
-burns
Hypovolemic shock
-the result of absolute deficiency in intravascular blood volume
-characterized by decrease in preload due to reduced stroke volume and cardiac output
Signs and symptoms of hypovolemic shock
-Tachypnea
-Tachycardia
-Normal-low bp (narrow pp)
-weak/absent peripheral pulses
-delayed cap refil
-cool pale diaphoretic
-changes in mental status
Treatment for hypovolemic shock
-20cc/kg bolus
-Reassess for signs of response to fluid therapy
-Repeat boluses until improvement
-blood products usually given after 2-3 boluses
Distributive shock
Inappropriate distribution of blood volume with inadequate organ and tissue perfusion
Common forms of distributive shock
-septic shock
-anaphylactic shock
-neurogenic shock
Physiology of Distributive Shock
Cardiac Output can be increased, normal or decreased
Tissue perfusion is compromised due to poor distribution of blood flow
Signs of distributive shock
Tachypnea
Tachycardia
Blood pressure will differ depending on type and severity
Warm flushed pale skin
Changes in mental status
Septic shock
The most common form of distributive shock
WBC’s stimulate release of inflammatory mediators (cytokines)
Cytokines produce vasodilation and increased capillary permeability
Can lead to multi organ system failure
Treatment for septic shock
-rapid aggressive fluid admin
-Antibiotics
-Determine response to Tx
Anaphylactic Shock
Results from severe reaction to drug, food, vaccine or other antigen
Acute multi system response characterized by vasodilation, increased capillary permeability and bronchoconstriction
Signs and symptoms of anaphylactic shock
-anxiety
-agitation
-N/V
-Urticaria
-Angioedema
-Resp distress
-Hypotension
-Tachycardia
Treatment for anaphylactic shock
-Epi
-Ventolin
-Antihistamines
-cortico steriods
Fluid therapy
Nerougenic shock
Results from injury to the head or spine that disrupts sympathetic NS inner action of heart and blood vessels
Signs and symptoms of neurogenic shock
-Hyptotension with widen pp
Normal HR or bradycardia
Diaphragmatic breathing
Treatment for neurogenic shock
Position patient flat or head down
Attempt fluid therapy
Vaspressors
Cardiogenic shock
-Primary disruption of the hearts pumping ability
In infants and young children, normally secondary to:
-Arrhythmias
-Congenital Heart Defects
-Myocardititis
Treatment
Cautious fluid resuscitation
Mechanical ventilation PRN
Obstructive shock
Condition of impaired cardiac output caused by physical obstruction of blood flow
Causes of obstructive shock
Cardiac tamponade
Tension pneumothorax
Massive pulmonary embolism
Obstructive shock
Results in low cardiac output, inadequate tissue perfusion and compensatory increase in systemic vascular resistance
Similar in presentation to hypovolemic shock
Progressive JVD
Treatment for obstructive shock
Treat the cause
