Pediatric Shock

Question 1

What is the Definition of Cardiac output?

Answer 1

The volume of blood pumped out per minute by the Ventricles of the heart.

Question 2

What is the most common cause of shock in Pediatrics?

Answer 2

Hypovolemic Shock(dehydration)
Septic Shock 2nd
Cardiogenic Shock

Question 3

What is the Equation for Cardiac Output?

Answer 3

HR x SV

Question 4

Waht are the components of Stroke volume?

Answer 4

Preload
Afterload
Contractility

Question 5

What are the components of Blood Pressure?

Answer 5

Cardiac Output + Systemic Vascular Resistnce

Question 6

How do children compensate for Drops in BP?

Answer 6

Increase Vascular resistance

VASOCONTRICTION

Question 7

How is cardiac output most strongly influenced in young children?

Answer 7

Increases in Heart Rate
(less myocardial muscle mass)
ALWAYS Pay attention to increased HR

Question 8

What is Preload?

Answer 8

End diastolic stretch provided by filling of the ventricles

Question 9

What is Contractility?

Answer 9

The force Generated during ventricular Systole

Question 10

What is Afterload?

Answer 10

The pressure needed to eject blood out of the ventricles

Question 11

How is systemic vasculr resistance assesed?

Answer 11

Capillary Refill

Question 12

What are the components of Cardiogenic Shock?

Answer 12

Increased Preload
Increased Afterload
DECREASED Contractility

Question 13

What are the components of Hypovolemic Shock?

Answer 13

Decreased Preload
Increased Afterload
Normal Contractility

Question 14

What are the Causes of Cardiogenic Shock?

Answer 14

Acquired HD: Rheumatic Fever
Cardiomyopathies
Non-Cardiac Causes: Pneumothorax
HyperK
Hypo Ca
Congenital: Large Ventricular Septal Defects

Question 15

What are the Clinical features of Cardiogenic shock?

Answer 15

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.

Question 16

How is cardiogenic shock diagnosed?

Answer 16

Studies:
ECG
Chest Radiography
Echo

Labs:
Glucose
Electrolytes
Ca
Blood Gasses
Cariac Ez
Viral Titers

Question 17

What is the goal of therapy for Cardiogenic Shock?

Answer 17

Increase perfusion of oxygenated blood to tissues

Question 18

What is the definition of a Bolus?

Answer 18

Large volume given quickly.

Have to give smaller bolus in cardiogenic shock!

Question 19

What should be given to kids with ductal dependant lesions in Cardiogenic shock? Why?

Answer 19

Prostaglandin E1 to maintain patent ductus arteriosus.

Better to be getting mixed blood than no blood!

Question 20

What can happen if you give too much fluid in cardiogenic shock?

Answer 20

Make it worse by increasing preload.

Question 21

What should be given to all patients in Cardiogenic shock?

Answer 21

Glucose need increases. Test glucose and give as needed.
Ca given if low to maximize contractility.
Also keep temp under control

Question 22

What meds should be given to a kid in cardiogenic shock

Answer 22

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

Question 23

What is used for Refractory Cardiogenic Shock?

Answer 23

Extracorporeal Membrane Oxygenation(ECMO)(Heart Lung machine)
Ventricular Assist devices
Heart Transplant