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Paediatrics > Paediatric Shock > Flashcards

Paediatric Shock Flashcards

1
Q

What is shock?

A

Lack of perfusion to the peripheries leading to a lack of adequate cellular metabolism, leading to the accumulation of cellular waste

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2
Q

What features are suggestive of septic shock?

A
  • Localising symptoms
  • Fulminant DIC with purpuric rash
  • NOT FEVER
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3
Q

Are patients with septic shock febrile?

A

NO. Fever is not the defining feature of septic shock. May be cold, euthermic or febrile.

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4
Q

What causes cold septic shock?

A
    1. Cardiac dysfunction due to lactic academy from septic process
    1. Children cannot increase SV, only inc HR to inc CO
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5
Q

What is warm septic shock? Features?

A

Vasodilatory:

  • fever
  • bounding pulse
  • wide pulse pressure
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6
Q

Young or older children more likely to present with warm septic shock?

A

The older the child, the more likely warm shock.

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7
Q

Mx septic shock?

A

Resuscitation Pod.

  • ABCs
  • Prompt ABx (within 30minutes of arrival).
  • Fluid resuscitation
  • Consider inotropes
  • Fluid, inotrope resistant = ECMO
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8
Q

Components of C in primary survey of septic shock?

A
  • 2x IV access attempts; prepare for IO / umbilical

- Bloods: B/C, BSL, VBG (for lactate)

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9
Q

Organisms to cover and ABx for neonates with septic shock?

A

Neonates (GBS, E coli, Listeria):

  • empirical: benzylpenicillin, cefotaxime.
  • If UTI: add gentamicin.
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10
Q

Older children: ABx and organisms in septic shock?

A

Older children (Staph, strep, meningicoccal ):

  • flucloxacillin
  • 3rd generation ceph (cefotaxime or ceftriaxone) for BBB access
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11
Q

Immunocompromised / neutropenic patients: ABx and organisms to cover in septic shock?

A
  • Tazocin: cover pseudomonas

- Vancomycin (MRSA)

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12
Q

Approach to fluid resuscitation in paediatric septic shock?

A

20ml/kg NS - 40ml/kg (in older children), then stand at the bed to watch the HR, peripheral perfusion
• With rapid assessment of another bolus, continue to bolus them
• Start drawing up inotropes if starting 40ml/kg
Neonatal be careful: as sepsis can masqeurade cardiogenic shock (CHD)

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13
Q

Why do septic shock patients respond poorly to fluid resuscitation?

A

Fluids resuscitation - do not respond as well to this because they have leaky vessels

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14
Q

Why is warm septic shock v cold septic shock important to determine when giving inotropes?

A
  • Warm shock, the problem is vasodilation: therefore give NA to vasoconstrict
  • Cold shock: adrenaline to increase pump
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15
Q

Why do neonates often get started on dobutamine?

A

Shock is more commonly cariogenic and cold septic shock.

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16
Q

Can NA and adrenaline be given peripherally?

A

Yes but diluted. Tissue necrosis if given undiluted.

17
Q

Post resuscitation care after septic shock?

A
  • Monitor BSL
  • Monitor BP and maintain
  • VBG: monitor CO2, electrolytes, pH
  • ABG is important to look at PO2 therefore take when intubated and lactate
18
Q

Which CHD lesions generally present in shock?

A

The PDA dependent lesions:

  • Critical AS
  • Coarctation
  • Transposition
19
Q

How do neonates with cardiogenic shock preesent?

A
  • Floppy
  • Cold
  • Mottled
  • Poor feeding
    (Looks similar to septic neonate).

+/-:

  • Murmur
  • Four limb BP
  • Decreased femoral pulses
20
Q

What are the causes of cardiogenic shock in older children?

A
  • Myocarditis
  • AMI
  • Ongoing SVT
21
Q

How long can umbilical artery / vein access be obtained?

A

Up to 4 days

22
Q

Mx cardiogenic shock?

A
  • AB
  • C: access
  • Cautious 10mL/kg NS
  • PGE
  • Still ABx as hard to differentiate
  • Dobutamine in most
23
Q

What is the biggest danger of PGE?

A

Apnoea. Must always prepare for:

  • intubation
  • transfer
24
Q

Causes of hypovolaemic shock?

A 
Fluid:
- Gastro
- DKA
Blood:
- Haemorrhage (trauma)
- Bleeding from PUD or GIT lesion
25
Q

Sites of occult blood loss?

A
  • Chest
  • Pelvis
  • Abdo
  • Long bones
  • Head (in neonates)
26
Q

Approach to hypovolemic shock?

A 
AB (with O2)
C:
- Gain access
- IVABx if ?sepsis
- Bloods: +UEC and BSL (?DKA)
-Fluid 20mL/kg: most resolve after first bolus. Keep bolus until out of shock and into dehydration (if correct DKA into normovolemia will get cerebral oedema)
27
Q

Aim of fluid bolus in hypovolemic shock? Why?

A

Keep bolusing until out of shock and into dehydration (if correct DKA into normovolemia will get cerebral oedema)

28
Q

What are the signs of cardiac tamponade?

A

Beck’s Triad:

  • Distended neck veins
  • Poor pulses
  • Muffled heart sounds
29
Q

Causes of obstructive shock?

A

Usually traumatic causes of:

  • Tension pneumo
  • Cardiac tamponade
  • PE (if adolescent on OCP)
30
Q

Mx of cardiac tamponade?

A
  • ABCD
  • Pericardial window
  • If arrest, then emergency pericardiocentesis
  • Echo to diagnose
31
Q

What is distributive shock?

A

i. e. anaphylaxis:
- Respiratory or CV features PLUS
- Mucocutaneous or GI effects

Paediatrics (31 decks)

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