Pediatric Shock

Question 1

What is the meaning of shock?

Answer 1

Inability to meet the cellular demand for oxygen (Oxygen delivery < Oxygen Consumption)

Question 2

What is the formula for cardiac output?

Answer 2

CO= HR X SV

Question 3

What can’t children modify well:
1) Cardiac Output
2) Heart Rate
3) Stroke Volume

Answer 3

3) Stroke Volume

Question 4

Stroke Volume is determined by:

Answer 4

1) Preload
2) Contractility
3) Afterload

Question 5

What is the formula for Oxygen Delivery?

Answer 5

DO2= CO X CaO2

Question 6

What is the formula for Oxygen Consumption?

Answer 6

Oxygen Consumption=CO X CvO2 -CaO2

Question 7

What is the formula for CaO2?

Answer 7

CaO2 = Hb bound O2+ Plasma Dissolved O2

Question 8

Normal oxygen extraction?

Answer 8

25-30%

Question 9

Normal oxygen consumption in an adult is:

Answer 9

250 ml/min

Question 9

What are the 5 types of Shock?

Answer 9

1) Cardiogenic
2) Hypovolemic
3) Distributive
4) Obstructive
5) Dissociative

Question 10

What are some causes of Cardiogenic Shock?

Answer 10

1) Congenital heart disease
2) Cardiomyopathies
3) Myocarditis
4) Abnormal rate or rythym

Question 11

What are some causes of Hypovolemic Shock?

Answer 11

1) Hemorrhagic
2) Plasma loss
3) Water loss
4) Relative hypovolemia

Question 12

What are some causes of Distributive Shock?

Answer 12

1) Sepsis
2) SIRS
3) Anaphylactic
4) Neurogenic

Question 13

What are some causes of Obstructive Shock?

Answer 13

1) Tension Pneumothorax
2) Cardiac Tamponade
3) Pulmonary embolism

Question 14

What are some causes of Dissociative Shock?

Answer 14

1) Cyanide poisoning
2) Carbon monoxide
3) Heat stroke

Question 15

What happens to the preload and afterload in Hypovolemic shock?

Answer 15

Preload: Decreased
Afterload: Increased

Question 16

What happens to the preload and afterload in Cardiogenic shock?

Answer 16

Preload: Increased
Afterload: Increased

Question 17

What happens to the preload and afterload in Distributive shock?

Answer 17

Preload: Decreased/No change
Afterload: Decreased

Question 18

What happens to the preload and afterload in Obstructive shock?

Answer 18

Preload: Increased
Afterload: Increased

Question 19

Management for shock?

Answer 19

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

Question 20

Start fluid resuscitation with __ ml/kg of isotonic crystalloid
as a push in patients with suspected cardiogenic shock.

Answer 20

10

Question 21

In Infants with suspected ductus dependant lessions start
____ drip to reopen the ductus.

Answer 21

Prostaglandin E1

Question 22

For Hemorrhagic Shock give __

Answer 22

PRBC’s

Question 23

In Refractory shock consider:

Answer 23

1) Adrenal Insufficiency
2) Dissociative shock

Question 24

What should you do if shock is not responding to anything?

Answer 24

Stat Echo to assess function and volume status

Question 25

To Improve contractility consider:

Answer 25

1) Milrinone
2) Dobutamine

Question 26

In Refractory shock send __ levels and start stress dose Hydrocortisone

Answer 26

Cortisol