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PALS > Shock > Flashcards

Shock Flashcards

1
Q

position to place child in if they are hypotensive and breathign isn’t compromised

A

Trendelenburg (supine, head 30 degrees below feet)

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2
Q

position to place child in if they are hypotensive and breathign isn’t compromised

A

Trendelenburg (supine, head 30 degrees below feet)

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3
Q

fluid resuscitation for shock

A

isotonic crystalloid in 20 mL/kg bolus over 5-20 minutes

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4
Q

fluid resuscitation for cardiogenic shock

A

5-10 ml/kg over 10-20 inutes

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5
Q

what does acidosis do to serum potassium concentration

A

increases

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6
Q

what can caused decreased ionized calcium concentration

A

sepsis, transfusion of blood products

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7
Q

most children with cardiogenic shock benefit form a _______ to decrease SVR and increase CO and tissue perfusion

A

vasodilator (provided BP is adequate)

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8
Q

what are the 3 inotropes? They increase cardiac contractility, HR, and variable on SVR

A

dopamine, epinephrine, dobutamine

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9
Q

this class of drugs decreases SVR, improves coronary artery blood flow and improves contractility

A

phosphodiesterase inhibitors (milrinone, inamrinone)

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10
Q

2 vasodilators that decreases SVR and venosu tone

A

nitroglycerin, nitroprusside

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11
Q

4 drugs that are vasopressors (increase SVR and myocardial contractility)

A

epinephrine
norepi
dopamine
vasopressin (doesn’t increase myocardiac contractility)

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12
Q

what are 2 isotonic crystalloid solutions

A

normal saline (NS) or lactated Ringer’s (LR)

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13
Q

where are isotonic crystalloids distributed

A

throughout the extracellular space (may need a large volume to restore intravascular volume fo rchildren)

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14
Q

what are colloid solutions

A

5% albumin, fresh frozen plasma, synthestic plasma expander (hetastarch), dextran40 and dextran 60

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15
Q

are colloid or isotonic crystalloid solutions better volume expanders

A

colloid solutions

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16
Q

disadvantages of colloids

A

less available, take time to prepare, blood derived can cause sensitivity reactions

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17
Q

when should blood products be considered

A

perfusion inadequate despite 2-3 boluses of 20mL/kg of isotonic crystalloid. then administer 10 mL/kg PRBCs ASAP

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18
Q

order of preference for blood products

A

crossmatched
type specific
type ) neg

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19
Q

this is present in stored blood and inadquate clearance of it can cause ionized hypocalcemia

A

citrate

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20
Q

if a patient becomes hypotensive during a rapid blood transfusion what shoudl be administered?

A

calcium

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21
Q

hypoglycemia in neonates

A
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22
Q

hypoglycemia in infants, children, adolescents

A
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23
Q

tx of hypoglycemia if you can’t administer glucose orally

A

IV glucose at 0.5-1 g/kg (IV dextrose as D25 (2-4mL/kg) of D10W (5-10 mL/kg)

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24
Q

type of dehydration where patients presents with poor skin turgor, marked oliguira, tachycardia, quiet tachypnea, sunken fontanel

A

moderate (10% in infants, 5-6% in adolescent)

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25
Q

type of dehydration with marked tachycardia, weak pulses, narrow pulse pressure, HPOTN

A

severe 15% in infants, 7-9% in adolescents

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26
Q

what is the 3mL to 1 mL rules

A

in hemorrhagic shock give about 3 mL of crystalloid for every 1 mL of blood lost

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27
Q

mild blood loss is less than what percentage?

A

30%

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28
Q

difference between moderate and severe blood loss

A

severe blood loss involved hypotension and no urine output

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29
Q

moderate blood loss percentage

A

30-45%

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30
Q

severe blood loss percentage

A

> 45%

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31
Q

what can help minimize adverse effects with blood administration

A

use a blood warminign device

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32
Q

are vasoactive agents routinely used for the management of hypovolemic shock

A

no

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33
Q

is sodium bicarb recommended for the treatment of metabolic acidosis secondary to hypovomeic shock

A

NO

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34
Q

when is bicarb indicated?

A

if metabolic acidosis is caused by significant bicarb losses from renal or GI losses (non-anion gap metagolic acidosis)

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35
Q

3 types of distributive shocks

A

septic, anaphylactic , neurogenic

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36
Q

first hour treatment for septic shock

A

Oxygen, vascular access
push repeated 20mL/kg boluses of isotonic crystalloid
correct hypoglycemia/ hypocalcemia
first dose abx STAT
consider stat vasopressor or stress dose hydrocortisone

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37
Q

if patient in septic shock doesn’t respond to fluids and is normotensive what drug should you start

A

dopamine

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38
Q

if patient is in warm septic shock (hypotensive vasodilated) what drug should you begin

A

norepi

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39
Q

if septic shock patient is in cold shock (hypotensive, vasoconstricted) what drug should you start

A

epineophrine

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40
Q

what is ScvO2

A

central venous oxygen saturation

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41
Q

ScvO2 goal

A

> 70%>

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42
Q

in septic shock if SCVO2 is >70%, and patietn ahs normal bp but poor perfusion what should you do

A

transfuse to Hgb>10
optomize arterial oxygen satruation, fluid boluses
consider milrinone or nitroprusse or dobutamine

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43
Q

if patient’s SCVO2 is

A

transfuse to >10g/dL
fluid boluses
consider epi or dobutamine + norepi

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44
Q

why is norepi preferred for warm shock

A

potent alpha vasoconstricting effects which raise DBP by increasing SVR. increases cardiac contractility w/ little chagne in HR

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45
Q

in norepi refractory shock what may be helpful

A

vasopressin infusion

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46
Q

what does vasopressin do

A

antagonizes the mechanism of sepsis-mediated vasodilation to help stabilze BP. No effect on cardiac contractility

47
Q

why is dopamine preferred for normotensive shock (impaired perfusion but adequate BP)

A

low doses- improves splanchnic and renal blood flow
intermediate dose- improve cardiac contractility
high doses- increases SVR

48
Q

you should use _____ vasoconstrcitor if the child has normal to high vascular resistance

A

epinephrine

49
Q

________ provides both inotropic and vasodilating effects, but often causes significant tachycardia and can reduct SVR and cause hypotension

A

dobutamine

50
Q

________ provides both inotropic and vasodilating effects, but offten causes significant tachycardia and can reduct SVR and cause hypotension

A

dobutamine

51
Q

fluid resuscitation for shock

A

isotonic crystalloid in 20 mL/kg bolus over 5-20 minutes

52
Q

fluid resuscitation for cardiogenic shock

A

5-10 ml/kg over 10-20 inutes

53
Q

what does acidosis do to serum potassium concentration

A

increases

54
Q

what can caused decreased ionized calcium concentration

A

sepsis, transfusion of blood products

55
Q

most children with cardiogenic shock benefit form a _______ to decrease SVR and increase CO and tissue perfusion

A

vasodilator (provided BP is adequate)

56
Q

what are the 3 inotropes? They increase cardiac contractility, HR, and variable on SVR

A

dopamine, epinephrine, dobutamine

57
Q

this class of drugs decreases SVR, improves coronary artery blood flow and improves contractility

A

phosphodiesterase inhibitors (milrinone, inamrinone)

58
Q

2 vasodilators that decreases SVR and venosu tone

A

nitroglycerin, nitroprusside

59
Q

4 drugs that are vasopressors (increase SVR and myocardial contractility)

A

epinephrine
norepi
dopamine
vasopressin (doesn’t increase myocardiac contractility)

60
Q

what are 2 isotonic crystalloid solutions

A

normal saline (NS) or lactated Ringer’s (LR)

61
Q

where are isotonic crystalloids distributed

A

throughout the extracellular space (may need a large volume to restore intravascular volume fo rchildren)

62
Q

what are colloid solutions

A

5% albumin, fresh frozen plasma, synthestic plasma expander (hetastarch), dextran40 and dextran 60

63
Q

are colloid or isotonic crystalloid solutions better volume expanders

A

colloid solutions

64
Q

disadvantages of colloids

A

less available, take time to prepare, blood derived can cause sensitivity reactions

65
Q

when should blood products be considered

A

perfusion inadequate despite 2-3 boluses of 20mL/kg of isotonic crystalloid. then administer 10 mL/kg PRBCs ASAP

66
Q

order of preference for blood products

A

crossmatched
type specific
type ) neg

67
Q

this is present in stored blood and inadquate clearance of it can cause ionized hypocalcemia

A

citrate

68
Q

if a patient becomes hypotensive during a rapid blood transfusion what shoudl be administered?

A

calcium

69
Q

hypoglycemia in neonates

A
70
Q

hypoglycemia in infants, children, adolescents

A
71
Q

tx of hypoglycemia if you can’t administer glucose orally

A

IV glucose at 0.5-1 g/kg (IV dextrose as D25 (2-4mL/kg) of D10W (5-10 mL/kg)

72
Q

type of dehydration where patients presents with poor skin turgor, marked oliguira, tachycardia, quiet tachypnea, sunken fontanel

A

moderate (10% in infants, 5-6% in adolescent)

73
Q

type of dehydration with marked tachycardia, weak pulses, narrow pulse pressure, HPOTN

A

severe 15% in infants, 7-9% in adolescents

74
Q

what is the 3mL to 1 mL rules

A

in hemorrhagic shock give about 3 mL of crystalloid for every 1 mL of blood lost

75
Q

mild blood loss is less than what percentage?

A

30%

76
Q

difference between moderate and severe blood loss

A

severe blood loss involved hypotension and no urine output

77
Q

moderate blood loss percentage

A

30-45%

78
Q

severe blood loss percentage

A

> 45%

79
Q

what can help minimize adverse effects with blood administration

A

use a blood warminign device

80
Q

are vasoactive agents routinely used for the management of hypovolemic shock

A

no

81
Q

is sodium bicarb recommended for the treatment of metabolic acidosis secondary to hypovomeic shock

A

NO

82
Q

when is bicarb indicated?

A

if metabolic acidosis is caused by significant bicarb losses from renal or GI losses (non-anion gap metagolic acidosis)

83
Q

3 types of distributive shocks

A

septic, anaphylactic , neurogenic

84
Q

first hour treatment for septic shock

A

Oxygen, vascular access
push repeated 20mL/kg boluses of isotonic crystalloid
correct hypoglycemia/ hypocalcemia
first dose abx STAT
consider stat vasopressor or stress dose hydrocortisone

85
Q

if patient in septic shock doesn’t respond to fluids and is normotensive what drug should you start

A

dopamine

86
Q

if patient is in warm septic shock (hypotensive vasodilated) what drug should you begin

A

norepi

87
Q

if septic shock patient is in cold shock (hypotensive, vasoconstricted) what drug should you start

A

epineophrine

88
Q

what is ScvO2

A

central venous oxygen saturation

89
Q

ScvO2 goal

A

> 70%>

90
Q

in septic shock if SCVO2 is >70%, and patietn ahs normal bp but poor perfusion what should you do

A

transfuse to Hgb>10
optomize arterial oxygen satruation, fluid boluses
consider milrinone or nitroprusse or dobutamine

91
Q

if patient’s SCVO2 is

A

transfuse to >10g/dL
fluid boluses
consider epi or dobutamine + norepi

92
Q

why is norepi preferred for warm shock

A

potent alpha vasoconstricting effects which raise DBP by increasing SVR. increases cardiac contractility w/ little chagne in HR

93
Q

in norepi refractory shock what may be helpful

A

vasopressin infusion

94
Q

what does vasopressin do

A

antagonizes the mechanism of sepsis-mediated vasodilation to help stabilze BP. No effect on cardiac contractility

95
Q

why is dopamine preferred for normotensive shock (impaired perfusion but adequate BP)

A

low doses- improves splanchnic and renal blood flow
intermediate dose- improve cardiac contractility
high doses- increases SVR

96
Q

you should use _____ vasoconstrcitor if the child has normal to high vascular resistance

A

epinephrine

97
Q

you should use ____ vasoconstrictor if the child has low vascular resistance

A

norepi

98
Q

________ provides both inotropic and vasodilating effects, but often causes significant tachycardia and can reduct SVR and cause hypotension

A

dobutamine

99
Q

a child in septic shock who is fluid refractory and dopamine dependents or norepi dependent may have what?

A

adrenal insufficiency

100
Q

if you suspect adrenal insufficiency what should be done?

A

hydrocortisone 2 mg/ kg IV bolus (max is 100 mg)

101
Q

an increase in cortisol

A

adrenal insufficiency

102
Q

most important treatment for anaphylactic shock

A

IM epi (1:1000), second dose may be needed 10-15 minutes after

103
Q

Treatment of anaphylactic shock

A

epi
aminister isotonic crytalloid fluid bolsues
albuterol PRN for bronchospasm
antihistamines (H1- diphenhydramine and H2- ranitidine)
corticosteroid (methylprednisolone)

104
Q

patient presents with HPOTN, bradycardia, and sometimes hypothermia

A

neurogenic shock

105
Q

BP in neurogenic shock

A

low DBP with a wide pulse pressure a fro loss of vascular tone

106
Q

Tx for neurogenic shock

A

child flat or head down
administer trial of fluid (for refractory norepi epi as indicated)
cooling and warming as needed

107
Q

do many children with cardiogenic shock require additional fluid therapy

A

no, as they have high preload (some may need fluid though )

108
Q

most effective way to increase stroke volume with cardiogenic shock

A

reduce afterload (SVR) rather than give an inotropic agent

109
Q

what type catheter evaluates left ventricular preload

A

pulmonary artery catheter

110
Q

this allow monitoring of central venous O2 saturation and measurement of central venous pressure

A

central venous access

111
Q

useful labs with cardiogenic shock

A 
ABG
hemoglobin
lactate
cardiac enzymes
thyroid function tests
112
Q

tx for cardiogenic shock in normotensive child

A

diuretics and vasodilators

113
Q

4 types of obstructive shock

A

cardiac tamponade, tension pneumo, ductal depdendent congenital heart lesions, massive PE

114
Q

immediate treatment needed for ductal dependent lesions

A

continuous infusion of prostaglandin E1 (PGE1) to restore ductal patency

PALS (4 decks)

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