shock

Question 1

what is a sign of late decompensated shock?

Answer 1

hypotension

Question 2

what are the signs of clinical shock?

Answer 2

• pale and cold extremities

- prolonged CRT

Question 3

what can be seen in both early shock and clinical dehydration?

Answer 3

• tachycardia
• tachypnoea
• reduced skin turgor
• reduced urine output

Question 4

what signs can you see in early (compensated) shock?

• BP
• HR
• respiration
• extremities
• UO

Answer 4

• BP (normal)
• HR (tachycardia)
• respiration (tachypnea)
• extremities (pale/mottled)
• UO (reduced)

Question 5

what signs can you see in late (decompensated) shock?

• BP
• HR
• respiration
• extremities
• UO

Answer 5

• BP (hypotension)
• HR (bradycardia)
• respiration (acidotic, Kussmaul)
• extremities (blue)
• UO (absent)

Question 6

what happens in early, compensated shock?

Answer 6

BP maintained by increased HR and RR, redistribution of blood from venous reserve volume and diversion of blood flow from non-essential tissues (which explains why peripheries will be cold and pale).

Question 7

what happens in late, decompensated shock?

Answer 7

compensatory mechanism fails, BP falls and lactic acidosis increases.

Question 8

what is the mx for early (compensated) shock?

Answer 8

urgent fluid resus

bolus 20ml/kg over less than 10 mins in children and young people

10-20ml/kg over less than 10 mins in term neonates

Question 9

what is the mx for children with severe DKA who are in shock? and why?

Answer 9

initial bolus of 10ml/kg of 0.9% NaCl, second bolus to be administered if necessary after discussion with specialist

to lower risk of cerebral oedema

Question 10

what categories do you use to assess hydration status?

Answer 10

• normal
• dehydrated
• shock

Question 11

what are signs of clinical dehydration?

Answer 11

• Appears to be unwell or deteriorating
• Decreased urine output
• Skin colour unchanged
• Warm extremities
• Altered responsiveness (for example, irritable, lethargic)
• Sunken eyes
• Dry mucous membranes
• Tachycardia
• Tachypnoea
• Normal peripheral pulses
• Normal capillary refill time
• Reduced skin turgor
• Normal blood pressure

Question 12

what are signs of clinical shock?

Answer 12

• Decreased level of consciousness
• Cold extremities
• Pale or mottled skin
• Tachycardia
• Tachypnoea
• Weak peripheral pulses
• Prolonged capillary refill time
• Hypotension

Question 13

what are features suggestive of hypernatraemic dehydration?

Answer 13

• jittery movements
• increased muscle tone
• hyperreflexia
• convulsions
• drowsiness or coma