Pediatric Shock Flashcards
What is the Definition of Cardiac output?
The volume of blood pumped out per minute by the Ventricles of the heart.
What is the most common cause of shock in Pediatrics?
Hypovolemic Shock(dehydration)
Septic Shock 2nd
Cardiogenic Shock
What is the Equation for Cardiac Output?
HR x SV
Waht are the components of Stroke volume?
Preload
Afterload
Contractility
What are the components of Blood Pressure?
Cardiac Output + Systemic Vascular Resistnce
How do children compensate for Drops in BP?
Increase Vascular resistance
VASOCONTRICTION
How is cardiac output most strongly influenced in young children?
Increases in Heart Rate
(less myocardial muscle mass)
ALWAYS Pay attention to increased HR
What is Preload?
End diastolic stretch provided by filling of the ventricles
What is Contractility?
The force Generated during ventricular Systole
What is Afterload?
The pressure needed to eject blood out of the ventricles
How is systemic vasculr resistance assesed?
Capillary Refill
What are the components of Cardiogenic Shock?
Increased Preload
Increased Afterload
DECREASED Contractility
What are the components of Hypovolemic Shock?
Decreased Preload
Increased Afterload
Normal Contractility
What are the Causes of Cardiogenic Shock?
Acquired HD: Rheumatic Fever Cardiomyopathies Non-Cardiac Causes: Pneumothorax HyperK Hypo Ca Congenital: Large Ventricular Septal Defects
What are the Clinical features of Cardiogenic shock?
Signs of oxygen deprivation to vital organs
Vague Symptoms: Poor Feeding, less activity
Older kids may appear fatigued and complain of Difficulty breathing or chest pain, syncope, or Alt Mental Status.
How is cardiogenic shock diagnosed?
Studies:
ECG
Chest Radiography
Echo
Labs: Glucose Electrolytes Ca Blood Gasses Cariac Ez Viral Titers
What is the goal of therapy for Cardiogenic Shock?
Increase perfusion of oxygenated blood to tissues
What is the definition of a Bolus?
Large volume given quickly.
Have to give smaller bolus in cardiogenic shock!
What should be given to kids with ductal dependant lesions in Cardiogenic shock? Why?
Prostaglandin E1 to maintain patent ductus arteriosus.
Better to be getting mixed blood than no blood!
What can happen if you give too much fluid in cardiogenic shock?
Make it worse by increasing preload.
What should be given to all patients in Cardiogenic shock?
Glucose need increases. Test glucose and give as needed.
Ca given if low to maximize contractility.
Also keep temp under control
What meds should be given to a kid in cardiogenic shock
Inotropic Agents
Vasopressors: Dopamine, dobutamine, epinephrine inc contractility and therefore SV
Milrinone, Nitroprusside, inhaled NO reduce afterload and inc. SV
Phenylephrine and NE should be AVOIDED! Worsen afterload
What is used for Refractory Cardiogenic Shock?
Extracorporeal Membrane Oxygenation(ECMO)(Heart Lung machine)
Ventricular Assist devices
Heart Transplant
