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2025 > PARA 3008 - SHOCK > Flashcards

PARA 3008 - SHOCK Flashcards

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1
Q

What is shock?

A

A state of circulatory dysfunction leading to inadequate tissue oxygen and nutrient delivery and accumulation of metabolic byproducts.

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2
Q

What are the main determinants of adequate tissue perfusion?

A

Blood volume, cardiac output, preload, afterload, cardiac contractility, hemoglobin concentration, and arterial oxygenation.

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3
Q

How is cardiac output calculated?

A

CO = Heart Rate × Stroke Volume

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4
Q

What is unique about children’s cardiac output?

A

It is more dependent on heart rate than stroke volume.

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5
Q

What is the stress performance curve?

A

A model showing that moderate stress enhances performance but excessive stress leads to decline or failure.

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6
Q

What are the physiological compensations in early shock?

A

Increased HR, increased RR, vasoconstriction, fluid retention.

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7
Q

What are signs of compensated shock?

A

Tachycardia, cool pale skin, prolonged cap refill, mild confusion, normal systolic BP, elevated diastolic BP.

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8
Q

What occurs during uncompensated shock?

A

Failure of compensatory mechanisms, anaerobic metabolism, acidosis, reduced perfusion.

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9
Q

What are signs of uncompensated shock?

A

Tachycardia, acidotic breathing, hypotension or normal BP, reduced urine output, depressed consciousness.

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10
Q

What is irreversible shock?

A

Permanent cellular damage even if perfusion is restored.

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11
Q

What is DIC and when can it occur?

A

Disseminated Intravascular Coagulation; triggered in irreversible shock by vessel damage and clotting cascade activation.

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12
Q

What is the general management of paediatric shock?

A

Oxygen, fluid bolus (10–20 mL/kg saline), temperature control, glucose if hypoglycemic, correction of metabolic issues.

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13
Q

What is the initial glucose treatment for a hypoglycemic child?

A

2–4 mL/kg of 10% dextrose if BGL <3 mmol/L.

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14
Q

What are the 5 main types of shock?

A

Hypovolaemic, distributive, obstructive, cardiogenic, and dissociative.

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15
Q

What are examples of hypovolaemic shock causes?

A

Hemorrhage, vomiting, diarrhea, burns, peritonitis.

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16
Q

What causes distributive shock?

A

Sepsis, anaphylaxis, spinal cord injury, vasodilating drugs.

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17
Q

What causes obstructive shock?

A

Tension pneumothorax, cardiac tamponade, PE, congenital obstruction.

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18
Q

What causes cardiogenic shock?

A

Arrhythmias, heart failure, myocarditis, congenital defects.

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19
Q

What causes dissociative shock?

A

Severe anemia, carbon monoxide poisoning, methemoglobinemia.

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20
Q

What is cold shock?

A

Decreased cardiac output with cool, mottled, cyanosed peripheries.

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21
Q

What is warm shock?

A

Vasodilation with flushed, warm skin due to peripheral perfusion.

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22
Q

What is the vasopressor of choice in cold shock?

A

Epinephrine: 0.05–0.3 mcg/kg/min.

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23
Q

What is the vasopressor of choice in warm shock?

A

Norepinephrine: 0.05–0.3 mcg/kg/min.

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24
Q

What is the treatment for duct-dependent congenital heart lesions?

A

Prostaglandin infusion to reopen ductus arteriosus, ventilation, fluid resuscitation.

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25
What is the AVPU scale?
A quick assessment of alertness: Alert, Voice, Pain, Unresponsive.
26
What are early signs of altered consciousness in paediatrics?
Disorientation to time, place, short-term memory, and then self.
27
What is a major structural cause of altered consciousness in children?
Trauma, infection, metabolic imbalance, space-occupying lesion.
28
What are signs of raised intracranial pressure (ICP)?
Cushing's triad: hypertension, bradycardia, irregular breathing.
29
What is the treatment for raised ICP in children?
Raise head, give mannitol or hypertonic saline, prevent vomiting, sedate, ventilate.
30
What are signs of meningitis or encephalitis?
Fever, altered mental status, photophobia, neck stiffness, seizures, rash (DIC).
31
What are differences between extradural and subdural hemorrhages?
Extradural is often convex, linked to skull fractures; subdural is crescent-shaped, from vein shearing.
32
What is the typical cause of a subarachnoid hemorrhage?
Aneurysmal rupture or trauma.
33
What is diffuse axonal injury?
Microscopic damage across white/gray matter from trauma causing long-term effects.
34
What is a seizure?
Sudden abnormal electrical activity in the brain causing motor, sensory, or behavioral disturbances.
35
What is the most important seizure management step in a child?
Maintain airway, time the seizure, administer oxygen, check BGL.
36
What is the first-line drug for seizures lasting >5 min?
Midazolam: 0.1–0.2 mg/kg IV/IM.
37
What are simple febrile convulsions?
Generalised tonic-clonic seizures <15 minutes, with postictal phase, in children aged 9m–5y with fever.
38
What is the management of simple febrile convulsions?
Reassure parents, treat fever, no need for long-term antiepileptics.
39
What is psychogenic coma?
A state of apparent unconsciousness without physiological cause; often psychiatric in origin.
40
What is syncope?
Transient loss of consciousness due to cerebral hypoperfusion.
41
How is syncope different from seizures?
No postictal phase in syncope; often triggered by standing, fear, or vasovagal causes.
42
What are red flags in paediatric syncope?
Exertional onset, family history of sudden death, known heart conditions.
43
What are signs of a serious head injury in a child?
LOC >5 min, abnormal mental status, focal neurological signs, signs of skull fracture.
44
What are the signs of compensated shock in a child?
Tachycardia, prolonged capillary refill, cool pale skin, mild agitation or confusion, reduced urine output, normal systolic BP.
45
What is the primary cause of metabolic acidosis in shock?
Anaerobic metabolism leading to lactate accumulation and CO₂ retention forming carbonic acid.
46
Why is metabolic acidosis dangerous in shock?
It reduces myocardial contractility and the effectiveness of catecholamines.
47
What is the hallmark sign of irreversible shock?
Continued deterioration despite resuscitation efforts; irreversible cell damage.
48
What are potential signs of Disseminated Intravascular Coagulation (DIC)?
Bleeding from gums, cannula sites, petechiae, purpura.
49
What initial steps should be taken in paediatric shock assessment?
A–E assessment, BGL check, rapid recognition, early oxygen and fluid therapy.
50
In paediatrics, what volume of fluid bolus is usually given initially in shock?
10–20 mL/kg of normal saline.
51
What are signs of paediatric septic shock?
Fever, drowsiness, pallor or mottling, poor feeding, rash, cold or hot extremities depending on phase.
52
How does sepsis cause distributive shock?
Systemic inflammatory response causes widespread vasodilation and capillary leakage.
53
Why does spinal cord injury lead to distributive shock?
Loss of sympathetic tone prevents vasoconstriction, causing vasodilation.
54
What distinguishes obstructive shock from other forms?
Obstruction physically limits blood flow despite normal cardiac function.
55
What are examples of internal causes of obstructive shock?
Pulmonary embolism, coarctation of aorta, congenital vascular obstruction.
56
What are examples of external causes of obstructive shock?
Tension pneumothorax, haemothorax, cardiac tamponade.
57
What is the primary treatment for cardiac tamponade?
Pericardiocentesis or surgical decompression.
58
In cardiogenic shock, why may fluids worsen the condition?
The heart is failing to pump, and excess volume can cause pulmonary oedema.
59
What is a key sign of duct-dependent congenital heart lesion?
Cyanosis not improving with oxygen and absent femoral pulses.
60
What medication is used to reopen a closed ductus arteriosus?
Prostaglandin infusion.
61
What is the classic triad of Cushing’s response?
Hypertension, bradycardia, and irregular respirations – late sign of raised ICP.
62
What is the purpose of raising the bed head in raised ICP?
To improve cerebral venous drainage and reduce intracranial pressure.
63
Why is mannitol used in raised ICP?
It is an osmotic diuretic that reduces cerebral oedema by pulling fluid from the brain tissue into the bloodstream.
64
What is the treatment dose for mannitol in raised ICP?
0.5 g/kg IV bolus.
65
How can hyperventilation help manage raised ICP temporarily?
Reduces CO₂ → causes cerebral vasoconstriction → lowers ICP.
66
What is the best way to differentiate between a febrile convulsion and a seizure?
Febrile seizures are generalised, <15 mins, 9m–5y, with postictal phase and full recovery.
67
What indicates an atypical febrile seizure?
Age outside 9m–5y, focal features, no postictal period, prolonged or recurrent seizures.
68
What is the first aid response to a paediatric seizure?
Protect airway, time the seizure, administer oxygen, check BGL, avoid restraint.
69
What drug and dose should be used if a seizure lasts over 5 minutes?
Midazolam: 0.1–0.2 mg/kg IV/IM.
70
What are neonatal seizures often caused by?
Hypoglycaemia, electrolyte imbalances, brain injury, or metabolic disorders.
71
How does a subdural haemorrhage appear on imaging?
Crescent-shaped bleed between dura and arachnoid mater.
72
What is the main cause of extradural (epidural) haemorrhage?
Skull fracture tearing meningeal artery; convex-shaped bleed.
73
What is diffuse axonal injury?
Microscopic shearing of brain tissue, causing widespread oedema and loss of consciousness.
74
What is the definition of coma?
A state of unresponsiveness to all stimuli with closed eyes and no awareness.
75
What does decorticate posturing indicate?
Damage to corticospinal tract above the brainstem (flexion).
76
What does decerebrate posturing indicate?
Brainstem damage (extension).
77
What are psychogenic causes of altered consciousness?
Catatonia, psychogenic coma, conversion disorders, malingering.
78
What is syncope caused by?
Transient cerebral hypoperfusion, often vasovagal or cardiac in origin.
79
How can you differentiate a seizure from syncope?
Syncope often lacks postictal phase and resolves quickly with lying flat.
80
What is a common precipitant of vasovagal syncope?
Fear, pain, prolonged standing, emotional distress.
81
What is a major red flag in paediatric syncope?
Exertional syncope (suggests cardiac origin like HCM or arrhythmia).
82
What is the major danger of carbon monoxide poisoning?
CO binds to haemoglobin more strongly than oxygen, preventing oxygen transport.
83
What is the treatment for CO poisoning?
High-flow 100% oxygen to displace CO from haemoglobin.
84
What are signs of sepsis in a child with altered LOC?
Fever, lethargy, rash, vomiting, seizures, poor feeding, tachycardia, cold extremities.
85
What is Cushing’s triad?
Bradycardia, hypertension, and irregular respiration – late sign of raised ICP.

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