Pedatric Cardiology & Shock

Question 1

Bradycardia

Answer 1

Most often occurs secondary to hypoxia
Treatment: a/w, O2
Other causes include congenital HB, beta blocker OD, calcium channel blockers OD, Digoxin OD

Question 2

What can increased ICP cause

Answer 2

Bradycardia, should be suspected in children with:
-ventricular shunts
-Hx of head injury
-suspected child abuse

Question 3

When do we begin compression

Answer 3

If the pulse is less than 60

Question 4

SVT with adequate perfusion

Answer 4

-doesn’t vary with activity
Heart rate >220 in infants and >180 in children
-consider adenosine

Question 5

SVT with poor perfusion

Answer 5

Vaal maneuvers (no delay)
Adenosine
Cardioversion

Question 6

Wide complex tachycardia with adequate perfusion

Answer 6

-ALS
Amiodarone
Cardioversion

Question 7

Wide complex tachycardia with poor perfusion

Answer 7

Cardioversion
Pharmacological intervention

Question 8

Infant chest compressions

Answer 8

2 fingers just below intermammary line
2 thumbs encircling technique
100-120 compressions per min

Question 9

Best sign of effective ventilation

Answer 9

Chest rise

Question 10

Best sign of effective circulation

Answer 10

Output with each compression

Question 11

What percent O2

Answer 11

100%, there is no risk in using 100% short term

Question 12

Fluid resuscitation

Answer 12

20cc/kg

Question 13

What is shock

Answer 13

The abnormal condition in which inadequate oxygen and metabolic substrates fail to meet the demands of the tissue

Question 14

What is compensated shock

Answer 14

Tissue perfusion maintained and blood pressure preserved

Question 15

Decompensated shock

Answer 15

-hypotensive
-unable to maintain organ perfusion

Question 16

Signs of compensated shock

Answer 16

-tachycardia
-cool, pale, diaphoretic skin
-delayed cap refill
-weak peripheral pulses/narrow pulse pressure
-vomiting

Question 17

A child can be in severe shock and still maintain what

Answer 17

B/P

Question 18

Hypotension is a sign of?

Answer 18

Irreversible organ injury and impending arrest

Question 19

Hypovolemic shock causes

Answer 19

Most common cause of shock in children
-diarrhea
-Hemorrhage
-Vomiting
-burns

Question 20

Hypovolemic shock

Answer 20

-the result of absolute deficiency in intravascular blood volume
-characterized by decrease in preload due to reduced stroke volume and cardiac output

Question 21

Signs and symptoms of hypovolemic shock

Answer 21

-Tachypnea
-Tachycardia
-Normal-low bp (narrow pp)
-weak/absent peripheral pulses
-delayed cap refil
-cool pale diaphoretic
-changes in mental status

Question 22

Treatment for hypovolemic shock

Answer 22

-20cc/kg bolus
-Reassess for signs of response to fluid therapy
-Repeat boluses until improvement
-blood products usually given after 2-3 boluses

Question 23

Distributive shock

Answer 23

Inappropriate distribution of blood volume with inadequate organ and tissue perfusion

Question 24

Common forms of distributive shock

Answer 24

-septic shock
-anaphylactic shock
-neurogenic shock

Question 25

Physiology of Distributive Shock

Answer 25

Cardiac Output can be increased, normal or decreased Tissue perfusion is compromised due to poor distribution of blood flow

Question 26

Signs of distributive shock

Answer 26

Tachypnea Tachycardia Blood pressure will differ depending on type and severity Warm flushed pale skin Changes in mental status

Question 27

Septic shock

Answer 27

The most common form of distributive shock WBC’s stimulate release of inflammatory mediators (cytokines) Cytokines produce vasodilation and increased capillary permeability Can lead to multi organ system failure

Question 28

Treatment for septic shock

Answer 28

-rapid aggressive fluid admin -Antibiotics -Determine response to Tx

Question 29

Anaphylactic Shock

Answer 29

Results from severe reaction to drug, food, vaccine or other antigen Acute multi system response characterized by vasodilation, increased capillary permeability and bronchoconstriction

Question 30

Signs and symptoms of anaphylactic shock

Answer 30

-anxiety -agitation -N/V -Urticaria -Angioedema -Resp distress -Hypotension -Tachycardia

Question 31

Treatment for anaphylactic shock

Answer 31

-Epi -Ventolin -Antihistamines -cortico steriods Fluid therapy

Question 32

Nerougenic shock

Answer 32

Results from injury to the head or spine that disrupts sympathetic NS inner action of heart and blood vessels

Question 33

Signs and symptoms of neurogenic shock

Answer 33

-Hyptotension with widen pp Normal HR or bradycardia Diaphragmatic breathing

Question 34

Treatment for neurogenic shock

Answer 34

Position patient flat or head down Attempt fluid therapy Vaspressors

Question 35

Cardiogenic shock

Answer 35

-Primary disruption of the hearts pumping ability In infants and young children, normally secondary to: -Arrhythmias -Congenital Heart Defects -Myocardititis

Question 36

Treatment

Answer 36

Cautious fluid resuscitation Mechanical ventilation PRN

Question 37

Obstructive shock

Answer 37

Condition of impaired cardiac output caused by physical obstruction of blood flow

Question 38

Causes of obstructive shock

Answer 38

Cardiac tamponade Tension pneumothorax Massive pulmonary embolism

Question 39

Obstructive shock

Answer 39

Results in low cardiac output, inadequate tissue perfusion and compensatory increase in systemic vascular resistance Similar in presentation to hypovolemic shock Progressive JVD

Question 40

Treatment for obstructive shock

Answer 40

Treat the cause