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PEDIATRICS > PEDIATRIC CRITICAL CARE 1.2 > Flashcards

PEDIATRIC CRITICAL CARE 1.2 Flashcards

1
Q

What are the goals for managing respiratory system dysfunction in shock?

A

Prevent/treat hypoxia and respiratory acidosis, prevent barotrauma, decrease work of breathing.

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2
Q

What are the therapies used to manage respiratory dysfunction in shock?

A

Oxygen, noninvasive ventilation, early endotracheal intubation, mechanical ventilation, PEEP, permissive hypercapnia, high-frequency ventilation, ECMO.

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3
Q

What are the goals for managing renal system dysfunction in shock?

A

Prevent/treat hypovolemia, hypervolemia, hyperkalemia, metabolic acidosis, hypernatremia/hyponatremia, and hypertension.

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4
Q

What are the therapies used for renal dysfunction in shock?

A

Monitor serum electrolytes, judicious fluid resuscitation, establish normal urine output and blood pressure, furosemide, dialysis, ultrafiltration, hemofiltration.

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5
Q

What are the goals for managing hematologic dysfunction in shock?

A

Prevent/treat bleeding, prevent/treat abnormal clotting.

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6
Q

What are the therapies for hematologic dysfunction in shock?

A

Vitamin K, fresh-frozen plasma, platelets, heparinization.

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7
Q

What are the goals for managing gastrointestinal dysfunction in shock?

A

Prevent/treat gastric bleeding, avoid aspiration and abdominal distention, avoid mucosal atrophy.

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8
Q

What are the therapies for gastrointestinal dysfunction in shock?

A

Histamine H2-receptor blockers or proton pump inhibitors, nasogastric tube, early enteral feedings.

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9
Q

What are the goals for managing endocrine dysfunction in shock?

A

Prevent/treat adrenal crisis.

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10
Q

What is the therapy for endocrine dysfunction in shock?

A

Stress-dose steroids in patients previously given steroids, physiologic dose for presumed primary insufficiency in sepsis.

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11
Q

What are the goals for managing metabolic dysfunction in shock?

A

Correct etiology, normalize pH.

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12
Q

What therapies are used for metabolic dysfunction in shock?

A

Fluids for hypovolemia, inotropic agents for poor cardiac function, improvement of renal acid excretion, low-dose sodium bicarbonate (if pH <7.1 and CO2 elimination is adequate).

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13
Q

What is the first inotrope to be administered in shock?

A

Dopamine.

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14
Q

What are the effects of dopamine in shock management?

A

Increases cardiac contractility, causes significant peripheral vasoconstriction at doses >10 μg/kg/min.

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15
Q

What is the dosing range for dopamine in shock?

A

3-20 μg/kg/min.

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16
Q

What are the risks associated with high doses of dopamine?

A

Increased risk of arrhythmias.

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17
Q

What are the effects of epinephrine in shock management?

A

Increases heart rate and cardiac contractility, acts as a potent vasoconstrictor.

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18
Q

What is the dosing range for epinephrine in shock?

A

0.05-3.0 μg/kg/min.

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19
Q

What are the risks of high-dose epinephrine?

A

May decrease renal perfusion, increase myocardial O2 consumption, and cause arrhythmias.

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20
Q

When can dobutamine be administered in shock management?

A

When dopamine is not enough.

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21
Q

What are the effects of dobutamine?

A

Increases cardiac contractility, acts as a peripheral vasodilator.

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22
Q

What is the dosing range for dobutamine?

A

1-10 μg/kg/min.

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23
Q

What are the effects of norepinephrine in shock management?

A

Potent vasoconstriction, no significant effect on cardiac contractility.

24
Q

What is the dosing range for norepinephrine in shock?

A

0.05-1.5 μg/kg/min.

25
Q

What are the effects of norepinephrine on blood pressure and afterload?

A

Increases blood pressure by increasing systemic vascular resistance, increases left ventricular afterload.

26
Q

What are the effects of phenylephrine in shock management?

A

Potent vasoconstriction.

27
Q

What is the dosing range for phenylephrine?

A

0.5-2.0 μg/kg/min.

28
Q

What are the risks associated with phenylephrine?

A

Sudden hypertension and increased oxygen consumption.

29
Q

What are the effects of nitroprusside in shock management?

A

Vasodilator, primarily arterial.

30
Q

What is the dosing range for nitroprusside?

A

0.5-4.0 μg/kg/min.

31
Q

What are the risks of prolonged nitroprusside use?

A

Risk of cyanide toxicity with use >96 hours.

32
Q

What are the effects of nitroglycerin in shock management?

A

Vasodilator, primarily venous.

33
Q

What is the dosing range for nitroglycerin?

A

1-20 μg/kg/min.

34
Q

What is the risk associated with nitroglycerin use?

A

Risk of increased intracranial pressure.

35
Q

What are the effects of prostaglandin E1 in shock management?

A

Vasodilator, maintains open ductus arteriosus in newborns with ductal-dependent congenital heart disease.

36
Q

What is the dosing range for prostaglandin E1?

A

0.01-0.2 μg/kg/min.

37
Q

What are the risks associated with prostaglandin E1?

A

Can cause hypotension and apnea.

38
Q

What are the effects of milrinone in shock management?

A

Increases cardiac contractility, improves cardiac diastolic function, causes peripheral vasodilation.

39
Q

What is the dosing range for milrinone?

A

Loading dose: 50 μg/kg over 15 minutes; maintenance dose: 0.5-1.0 μg/kg/min.

40
Q

What type of drug is milrinone, and what is its mechanism?

A

Milrinone is a phosphodiesterase inhibitor that slows cyclic adenosine monophosphate breakdown.

41
Q

What are the initial resuscitation steps for respiratory distress and hypoxemia in pediatric shock?

A

Start with face mask oxygen, high-flow nasal cannula oxygen, or NP CPAP. Use peripheral IV or intraosseous access for fluid resuscitation and inotrope infusion. Perform mechanical ventilation if necessary after cardiovascular resuscitation.

42
Q

What are the therapeutic endpoints of resuscitation in pediatric septic shock?

A

Capillary refill ≤2 sec, normal blood pressure for age, normal pulses, warm extremities, urine output >1 mL/kg/hr, normal mental status, ScvO2 saturation ≥70%, and cardiac index 3.3-6.0 L/min/m2.

43
Q

When should empiric antibiotics be administered in severe sepsis?

A

Within 1 hour of identification of severe sepsis. Blood cultures should be obtained first if possible but must not delay antibiotics.

44
Q

What antibiotics are recommended for newborns (0-2 months) with severe sepsis?

A

Antibiotics targeting gram-negative organisms such as Escherichia coli and Listeria monocytogenes.

45
Q

What is the fluid resuscitation protocol for hypovolemic shock in pediatric patients?

A

Use isotonic crystalloids or albumin, with boluses of up to 20 mL/kg over 5-10 minutes, titrated to reverse hypotension and improve urine output, capillary refill, and consciousness.

46
Q

What condition requires vasodilator therapy along with inotropes in pediatric shock?

A

Low cardiac output with elevated systemic vascular resistance and normal blood pressure.

47
Q

When should extracorporeal membrane oxygenation (ECMO) be considered in pediatric shock?

A

For refractory pediatric septic shock and respiratory failure.

48
Q

What are the indications for hydrocortisone therapy in pediatric sepsis?

A

Fluid refractory, catecholamine-resistant shock and suspected or proven adrenal insufficiency.

49
Q

What is the hemoglobin target during resuscitation in pediatric sepsis with low ScvO2 (<70%)?

A

10 g/dL during resuscitation and >7.0 g/dL after stabilization and recovery.

50
Q

What is the recommended glycemic control target in pediatric sepsis?

A

Control hyperglycemia with a target ≤180 mg/dL. Provide glucose infusion alongside insulin therapy.

51
Q

What is the definition of drowning?

A

The process of experiencing respiratory impairment from submersion or immersion in liquid.

52
Q

What are the three main pathophysiologies of drowning?

A

Anoxic-ischemic injury, pulmonary injury, and cold water injury/hypothermia.

53
Q

What are the risk factors for drowning?

A

Age, male gender, access to water, floodwaters, unsupervised infants, alcohol, medical conditions, unfamiliarity with the place, low socioeconomic status, and rural populations.

54
Q

What is the management priority for a drowning victim?

A

Focus on airway clearance, oxygenation, ventilation, and restoring circulation. Protect the cervical spine if trauma is suspected.

55
Q

What is the best prognosticator of long-term CNS outcomes in drowning victims?

A

Neurologic examination and progression during the first 24-72 hours post-submersion.

56
Q

What preventive measures reduce drowning risks?

A

Learn life-saving skills (swimming), use barriers like fences, enforce life jacket use, and provide vigilant supervision.

PEDIATRICS (19 decks)

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