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Infant Transport Team > Shock > Flashcards

Shock Flashcards

1
Q

Name the three categories of cardiogenic shock

A
  1. cardiomyopathic
  2. mechanical
  3. arrythmogenic
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2
Q

In the context of neonatology, name pathologies responsible for mechanical cardiogenic shock

A
  1. congenital heart disease/PDA depend lesions
  2. PPHN
  3. valuopathies (ie, aortic stenosis, pulmonary valve atresia/stensosis, mitral insuffency)
  4. acute myocardial ischemia
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3
Q

Causes of cardiomyopathic cardiogenic shock in neonates

A
  • HOCM w/ SAM (hyperinsulinemia)
  • viral/bacteerial cardiomyopathies

-dilated, restrictive, hypertrophic

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4
Q

causes of obstructive shock in neonates

A

PPHN
Tension pneumothorax
pulmonary embolism (rare)
cardiac tamponade (rare)

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5
Q

causes of distributive shock in neonates

A
  • Sepsis (early + late)
  • iatrogenic (iNO, dobutamine, anesthetics and analgesic rx)
  • liver failure
  • adrenal insufficiency
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6
Q

causes of hemorrhagic shock in neonates

A
  1. subgaleal hemorrhage
  2. fetomaternal hemorrhage
  3. vasa previa
  4. internal hemorrhage (IVH/NEC)
  5. Twin to twin transfusion
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7
Q

causes of non-hemorrhagic hypovolemic shock in neonates

A
  1. insensible fluid loss (bili lights, skin, low reserves)

2. diarrhea, vomiting

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8
Q

common causes of hemodynamic instability in preterm neonates

A

-Failed adaptation to transition
-PDA
-Sepsis/NEC
-Low pulmonary BF
(PPHN, High MAP)

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9
Q

Common causes of hemodynamic instability in the term neonate

A

HIE (acidosis complications)
Pulmonary HTN
Sepsis
Septal hypertrophy (GDM)

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10
Q

Factors contributing to low DBP

A

VASODILATION
-sepsis/nec/rx

ENLARGED VASCULAR TONE
-HD significant PDA/AVM/Giant hemangioma/Bronchopulmonary sequestion

HYPOVOLEMIA
-Cap leak/hemorrhage/transepidural h20 loss, excessive diuresis

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11
Q

Factors contributing to low SBP

A
  1. Low PBF (rv dysfunction, high MAP, PPHN, Obstructed PV)
  2. Impaired Filling (HOCM, cardiac tamponade, T.PTX)
  3. Structural/rhythm/myocardial injury
    (CHD, SVT/VT, TMI, Cardiomyopathy)
  4. Failed transition
    (removal of placenta/PDA)
  5. Vasoconstriction (exogenous, cold sepsis, pressors)
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12
Q

Rational for Hydrocortisone in shock

A

Data suggests that critical illness induces a state of absolute or relative adrenal insufficiency that may contribute to shock.

The purpose of administering glucocorticorticoids to patients with sepsis is to restore a balance to the HPA-axis, with the end goal of improving clinically meaningful outcomes such as mortality

Also, neonates dont have the endogenous ability to secrete cortisol the same as an adult is able to

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13
Q

Hydrocortison onset and pharmacodynamic

A

A short acting corticosteroid with minimal sodium-retaining potential. it decreases inflammation by suppression of migration of polymorphonuclear leukocytes and reversal of increased capillary permeability.

onset 1 hour

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14
Q

When to consider Hydrocortison?

A

Once on 2 line vasopressors

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15
Q

Hemodynamic significant PDA tx

A
  1. Ductal closure strategies (NSAIDs, Tylenol, surgery)
  2. Flow limitation strategies
    (permissive hypercapnia, increase PEEP)
  3. Enhance LV systolic function (dobutamine)
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16
Q

Neonatal sepsis mgmt

A
  1. Initial stabilization (resp support)
  2. establish access
  3. admin fluids (10-20ml/kg)
  4. monitoring/cultures
  5. fluid resus 10-20ml/kg, typically nothing >30ml/kg. MAX 60ml/kg (RARE)
  6. Abx (amp/gent <72h) (clox + gentamicin >72h) (cefotaxime and Vanco) (acyclovir for viral/neuro coverage)
  7. pressors (epi, vaso, levo)
  8. Hydrocortisone
17
Q

what receptors does DOBUTAMINE work on

A

aBBB

18
Q

what effects does DOBUTAMINE do do SVR

A

decrease SVR because of Beta 2 receptors.

19
Q

Effects of DOBUTAMINE on PVR

A

decrease PVR

20
Q

what site does MILRINONE work on

A

cAMP

21
Q

what effects does Milirnone has on the heart

A

+++ inotrope/chronotropy

22
Q

Milirnone effect on PVR

A

++ decrease

23
Q

Milirnone effect on SVR

A

++ decrease

24
Q

Isoproterenol target receptors

A

BBBB

25
Q

Isoproterenol effects on HR/chronotropy

A

+++++

26
Q

Vasopressin receptor targets

A

V1 and V2

27
Q

Vasopressin effect on HR

A

decrease + 1

28
Q

vasopressin effect on SVR

A

+++ increase

29
Q

Vasopressin effect on PVR

A

decrease + 1

30
Q

Phenylephrine effect on PVR

A

++ 2

31
Q

Phenylephrine effect on HR

A

decrease + 1

32
Q

Norepi target receptors

A

aaaB

33
Q

Levo effects on PVR

A

variable

34
Q

Dopamine receptor sites

A

D-receptors (1-4mcg/kg/min)
aBBBD (5-10mcg/kg/m)
aaaBD (10-20mcg/kg/min)

Infant Transport Team (14 decks)

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