pediatric emergencies Flashcards
what are pediatric emergencies
- Early recognition and acute management of shock
- Respiratoryfailure
- Meningitis
- Seizures
- Burn
shock definition
Shock:
an acute complex dyfunction of the circulatory system irrespective of the cause,which results in impaired tissue perfusion,
thus,in the failure of meeting the oxygen and metabolic demand of the tissues
causes of shock
- decrease in the intravascular volume
*dysfunction of the cardiovascular system - Imbalance of the different fluid spaces
in case of compensated shock
how is the perfusion?
there’s no hypoperfusion
Compensated shock
Centralization of the circulation and tachycardia in order to maintain the circulation of the vital organs
decompensated shock
Disease progression can lead to the impairment of the vital organs with cardiovascular dysfunction ,
acute lung injury OR
dysfunction of two or more organs (coagulopathy, thrombocytopenia, hypotension or hypoperfusion
increased creatinine
bilirubin >34.2
what is cardiovascular dysfunction ?
is it in compensated or decompensated??
if the patient is hypotensive or blood pressure can only be maintained with vasopressors,
OR if two is true from the followings:
metabolic acidosis,
increased arterial lactate, oliguria, prolonged capillary refill time.
irreversible shock
without intervention a decompensated shock can lead to irreversible injury, MOF, death
cardiogenic shock
obstructive shock
hypovolemic
distributive shock
how to recognize shock
what is the earliest and most characteristic symptom of shock?
Tachycardia
does absence of tachycardia exclude shock?
NO
Incase of spinal injury, certain drugs (BB) heart rate can be normal
hypoxia effect on heart rate
bradycardia
symptoms of shock
- tachycardia
- tachypnoe : with respiratory distress
- Impaired peripheral circulation ( due to centralization of circulation, the skin perfusion is impaired.; cold)
- impaired end organ perfusion : most common is decreased consciousness and oliguria
levels of decreased consciousness
irritability
agitation
apathy
somnolence
what is BBB approach?
breathing
body color
behavior
what should you think of when u see early petechia
meningococcal meningitis
what increases CRT
fever
cold
can be low BP
etc..
What isa LATE SIGN of shock in infants and children
Hypotension
if hypoperfusion is present does it confirm shock?
YES
What should you take into count when evaluating hypotension?
always take age into count
value of hypotension in newborn
<60 mmHg systolic BP
value of hypotension in infants
<70 mmhg systolic BP
VALUE FOR HYPOTENSION for 1-9 years old
systolic BP <70 mmhg + (2 x age)
value of hypotension for 10 years old or older
systolic BP <90mmhg
Heart rates for different ages
Does shock require laboratory tests?
No, they are not necessary because shock is a clinical diagnosis!
when to correct hypoglycemia
<3 mmol/l
what is used to correct hypoglycemia? what is the target value?
Rapid dextrose infusion
Target = 3.9- 8.3 mmol/l
if you notice patient might be in anaphylaxis shock would u administer Epinephrin before confirming?
YES because if we dont give it patient might die
but if we do it’s no problem
if septic shock is resistant to catecholamines what to give?
what dysfunction might be the cause?
steroids (hydrocortisone 2mg/kg)
think of adrenal dysfunction
most common cause of cardiac arrest in childhood is
(from breathing disorders)
apnea
how to treat croup
- steroid (rectal, oral)
- epinephrin ( acts on upper airways, decreases edema )
