Pediatric Shock Flashcards
What is the meaning of shock?
Inability to meet the cellular demand for oxygen (Oxygen delivery < Oxygen Consumption)
What is the formula for cardiac output?
CO= HR X SV
What can’t children modify well:
1) Cardiac Output
2) Heart Rate
3) Stroke Volume
3) Stroke Volume
Stroke Volume is determined by:
1) Preload
2) Contractility
3) Afterload
What is the formula for Oxygen Delivery?
DO2= CO X CaO2
What is the formula for Oxygen Consumption?
Oxygen Consumption=CO X CvO2 -CaO2
What is the formula for CaO2?
CaO2 = Hb bound O2+ Plasma Dissolved O2
Normal oxygen extraction?
25-30%
Normal oxygen consumption in an adult is:
250 ml/min
What are the 5 types of Shock?
1) Cardiogenic
2) Hypovolemic
3) Distributive
4) Obstructive
5) Dissociative
What are some causes of Cardiogenic Shock?
1) Congenital heart disease
2) Cardiomyopathies
3) Myocarditis
4) Abnormal rate or rythym
What are some causes of Hypovolemic Shock?
1) Hemorrhagic
2) Plasma loss
3) Water loss
4) Relative hypovolemia
What are some causes of Distributive Shock?
1) Sepsis
2) SIRS
3) Anaphylactic
4) Neurogenic
What are some causes of Obstructive Shock?
1) Tension Pneumothorax
2) Cardiac Tamponade
3) Pulmonary embolism
What are some causes of Dissociative Shock?
1) Cyanide poisoning
2) Carbon monoxide
3) Heat stroke
What happens to the preload and afterload in Hypovolemic shock?
Preload: Decreased
Afterload: Increased
What happens to the preload and afterload in Cardiogenic shock?
Preload: Increased
Afterload: Increased
What happens to the preload and afterload in Distributive shock?
Preload: Decreased/No change
Afterload: Decreased
What happens to the preload and afterload in Obstructive shock?
Preload: Increased
Afterload: Increased
Management for shock?
1) Administer FiO2
2) Intubate If Airway is compromised or patient in impending Respiratory Failure
3) Establish Vascular Access
4) Start fluid resuscitation with 20 ml/kg of isotonic crystalloid
as a push
5) Check blood sugar and serum electrolytes
6) If anaphylaxis suspected give epinephrine, diphenhydramine
and hydrocortisone. Conside H2 blocker
7) Continuous monitoring of HR, RR, BP, SaO2 & Urine output
Start fluid resuscitation with __ ml/kg of isotonic crystalloid
as a push in patients with suspected cardiogenic shock.
10
In Infants with suspected ductus dependant lessions start
____ drip to reopen the ductus.
Prostaglandin E1
For Hemorrhagic Shock give __
PRBC’s
In Refractory shock consider:
1) Adrenal Insufficiency
2) Dissociative shock
What should you do if shock is not responding to anything?
Stat Echo to assess function and volume status
To Improve contractility consider:
1) Milrinone
2) Dobutamine
In Refractory shock send __ levels and start stress dose Hydrocortisone
Cortisol
