Shock Flashcards
What is shock?
Where the circulation is inadequate to meet the metabolic demands of the tissues
Who is shock common in?
Critically ill children
Is shock caused by one thing?
No - there are varied reasons
How does the fluid intake requirement per kg of body weight in children compare to adults?
It is much higher
Why is the fluid intake requirement per kg of body weight in children higher than in adults?
- Higher surface area-to-volume ratio
- Higher basal metabolic rate
What factors may cause a child to become dehydrated?
- Unable to take oral fluids
- Additional loss of fluids
- Loss of fluid retaining mechanisms
What can cause inability to take oral fluids?
- Decreased consciousness
- Vomiting
What can cause additional fluid losses?
- Diarrhoea
- Fever
- Increased sweating
What can cause loss of normal fluid retention mechanisms?
- Burns
- Increased urinary loss
- Capillary leak
How can blood pressure be maintained in early shock?
- Increase HR
- Increased RR
- Diversion of blood flow from non-essential tissues to vital organs
- Redistribution of blood from venous reserve volume
What happens in late shock?
Compensatory mechanisms fail, BP falls and lactic acidosis increases
Why is it important to recognise early compensated shock?
It can be reversible, decompensated shock may not be
What are the different categories of shock?
- Hypovolaemic
- Distributive
- Cardiogenic
- Neurogenic
What can cause hypovolaemic shock?
- Haemorrhage
- Dehydration e.g. vomiting
- Burns
- Diabetic ketoacidosis
- Sepsis
What can cause distributive shock?
- Sepsis
- Anaphylaxis
What can cause cardiogenic shock?
- Arrhythmias
- Heart failure
What can cause neurogenic shock?
Spinal cord injury
What are the risk factors for shock?
- Pre-existing dehydration
- Pre-existing heart disease
What causes the symptoms of shock?
- Compensatory physiological changes
- Poor perfusion to tissues
What are the symptoms of early, compensated shock?
- Tachycardia
- Tachypnoea
- Decreased skin turgor
- Sunken eyes and fontanelles
- Delayed cap refill
- Mottled, pale, cold skin
- Core-peripheral temperature gap > 4 degrees
- Decreased urine output
What are the symptoms of late, decompensated shock?
- Acidotic breathing
- Bradycardia
- Confusion
- Blue peripheries
- Absent urine output
- Hypotension
What investigations should be performed in suspected shock?
- ABG including lactate
- FBC
- Urea and creatinine
What are the differentials for shock?
- Simple hypotension
- Syncope or pre-syncope
What is the priority for management of shock?
Rapid restoration of intravascular circulatin volume with IV fluid resuscitation
What fluids are normally given in fluid resuscitation in shock?
- 0.9% saline
- Blood (if due to haemorrhage)
What should be given following replacement of fluid deficit?
Maintenance fluids
How are maintenance fluids calculated for children?
- For first 10kg = 100ml/kg/24 hours
- For second 10kg = 50ml/kg/24 hours
- For subsequent kg’s = 20ml/kg/24 hours
If there is no improvement following fluid resuscitation or there is progression or respiratory failure who should be contacted?
PICU
What may a child need for shock in PICU?
- Tracheal intubation
- Mechanical ventilation
- Invasive BP monitoring
- Ionotropic support
- Correction of haematological, biochemical and metabolic derangements
- Support of renal failure
What are the potential complications of shock?
- Multiple organ dysfunction
- End-organ damage
- Death
