PEDIATRIC CRITICAL CARE 1.2

Question 1

What are the goals for managing respiratory system dysfunction in shock?

Answer 1

Prevent/treat hypoxia and respiratory acidosis, prevent barotrauma, decrease work of breathing.

Question 2

What are the therapies used to manage respiratory dysfunction in shock?

Answer 2

Oxygen, noninvasive ventilation, early endotracheal intubation, mechanical ventilation, PEEP, permissive hypercapnia, high-frequency ventilation, ECMO.

Question 3

What are the goals for managing renal system dysfunction in shock?

Answer 3

Prevent/treat hypovolemia, hypervolemia, hyperkalemia, metabolic acidosis, hypernatremia/hyponatremia, and hypertension.

Question 4

What are the therapies used for renal dysfunction in shock?

Answer 4

Monitor serum electrolytes, judicious fluid resuscitation, establish normal urine output and blood pressure, furosemide, dialysis, ultrafiltration, hemofiltration.

Question 5

What are the goals for managing hematologic dysfunction in shock?

Answer 5

Prevent/treat bleeding, prevent/treat abnormal clotting.

Question 6

What are the therapies for hematologic dysfunction in shock?

Answer 6

Vitamin K, fresh-frozen plasma, platelets, heparinization.

Question 7

What are the goals for managing gastrointestinal dysfunction in shock?

Answer 7

Prevent/treat gastric bleeding, avoid aspiration and abdominal distention, avoid mucosal atrophy.

Question 8

What are the therapies for gastrointestinal dysfunction in shock?

Answer 8

Histamine H2-receptor blockers or proton pump inhibitors, nasogastric tube, early enteral feedings.

Question 9

What are the goals for managing endocrine dysfunction in shock?

Answer 9

Prevent/treat adrenal crisis.

Question 10

What is the therapy for endocrine dysfunction in shock?

Answer 10

Stress-dose steroids in patients previously given steroids, physiologic dose for presumed primary insufficiency in sepsis.

Question 11

What are the goals for managing metabolic dysfunction in shock?

Answer 11

Correct etiology, normalize pH.

Question 12

What therapies are used for metabolic dysfunction in shock?

Answer 12

Fluids for hypovolemia, inotropic agents for poor cardiac function, improvement of renal acid excretion, low-dose sodium bicarbonate (if pH <7.1 and CO2 elimination is adequate).

Question 13

What is the first inotrope to be administered in shock?

Answer 13

Dopamine.

Question 14

What are the effects of dopamine in shock management?

Answer 14

Increases cardiac contractility, causes significant peripheral vasoconstriction at doses >10 μg/kg/min.

Question 15

What is the dosing range for dopamine in shock?

Answer 15

3-20 μg/kg/min.

Question 16

What are the risks associated with high doses of dopamine?

Answer 16

Increased risk of arrhythmias.

Question 17

What are the effects of epinephrine in shock management?

Answer 17

Increases heart rate and cardiac contractility, acts as a potent vasoconstrictor.

Question 18

What is the dosing range for epinephrine in shock?

Answer 18

0.05-3.0 μg/kg/min.

Question 19

What are the risks of high-dose epinephrine?

Answer 19

May decrease renal perfusion, increase myocardial O2 consumption, and cause arrhythmias.

Question 20

When can dobutamine be administered in shock management?

Answer 20

When dopamine is not enough.

Question 21

What are the effects of dobutamine?

Answer 21

Increases cardiac contractility, acts as a peripheral vasodilator.

Question 22

What is the dosing range for dobutamine?

Answer 22

1-10 μg/kg/min.

Question 23

What are the effects of norepinephrine in shock management?

Answer 23

Potent vasoconstriction, no significant effect on cardiac contractility.

Question 24

What is the dosing range for norepinephrine in shock?

Answer 24

0.05-1.5 μg/kg/min.

Question 25

What are the effects of norepinephrine on blood pressure and afterload?

Answer 25

Increases blood pressure by increasing systemic vascular resistance, increases left ventricular afterload.

Question 26

What are the effects of phenylephrine in shock management?

Answer 26

Potent vasoconstriction.

Question 27

What is the dosing range for phenylephrine?

Answer 27

0.5-2.0 μg/kg/min.

Question 28

What are the risks associated with phenylephrine?

Answer 28

Sudden hypertension and increased oxygen consumption.

Question 29

What are the effects of nitroprusside in shock management?

Answer 29

Vasodilator, primarily arterial.

Question 30

What is the dosing range for nitroprusside?

Answer 30

0.5-4.0 μg/kg/min.

Question 31

What are the risks of prolonged nitroprusside use?

Answer 31

Risk of cyanide toxicity with use >96 hours.

Question 32

What are the effects of nitroglycerin in shock management?

Answer 32

Vasodilator, primarily venous.

Question 33

What is the dosing range for nitroglycerin?

Answer 33

1-20 μg/kg/min.

Question 34

What is the risk associated with nitroglycerin use?

Answer 34

Risk of increased intracranial pressure.

Question 35

What are the effects of prostaglandin E1 in shock management?

Answer 35

Vasodilator, maintains open ductus arteriosus in newborns with ductal-dependent congenital heart disease.

Question 36

What is the dosing range for prostaglandin E1?

Answer 36

0.01-0.2 μg/kg/min.

Question 37

What are the risks associated with prostaglandin E1?

Answer 37

Can cause hypotension and apnea.

Question 38

What are the effects of milrinone in shock management?

Answer 38

Increases cardiac contractility, improves cardiac diastolic function, causes peripheral vasodilation.

Question 39

What is the dosing range for milrinone?

Answer 39

Loading dose: 50 μg/kg over 15 minutes; maintenance dose: 0.5-1.0 μg/kg/min.

Question 40

What type of drug is milrinone, and what is its mechanism?

Answer 40

Milrinone is a phosphodiesterase inhibitor that slows cyclic adenosine monophosphate breakdown.

Question 41

What are the initial resuscitation steps for respiratory distress and hypoxemia in pediatric shock?

Answer 41

Start with face mask oxygen, high-flow nasal cannula oxygen, or NP CPAP. Use peripheral IV or intraosseous access for fluid resuscitation and inotrope infusion. Perform mechanical ventilation if necessary after cardiovascular resuscitation.

Question 42

What are the therapeutic endpoints of resuscitation in pediatric septic shock?

Answer 42

Capillary refill ≤2 sec, normal blood pressure for age, normal pulses, warm extremities, urine output >1 mL/kg/hr, normal mental status, ScvO2 saturation ≥70%, and cardiac index 3.3-6.0 L/min/m2.

Question 43

When should empiric antibiotics be administered in severe sepsis?

Answer 43

Within 1 hour of identification of severe sepsis. Blood cultures should be obtained first if possible but must not delay antibiotics.

Question 44

What antibiotics are recommended for newborns (0-2 months) with severe sepsis?

Answer 44

Antibiotics targeting gram-negative organisms such as Escherichia coli and Listeria monocytogenes.

Question 45

What is the fluid resuscitation protocol for hypovolemic shock in pediatric patients?

Answer 45

Use isotonic crystalloids or albumin, with boluses of up to 20 mL/kg over 5-10 minutes, titrated to reverse hypotension and improve urine output, capillary refill, and consciousness.

Question 46

What condition requires vasodilator therapy along with inotropes in pediatric shock?

Answer 46

Low cardiac output with elevated systemic vascular resistance and normal blood pressure.

Question 47

When should extracorporeal membrane oxygenation (ECMO) be considered in pediatric shock?

Answer 47

For refractory pediatric septic shock and respiratory failure.

Question 48

What are the indications for hydrocortisone therapy in pediatric sepsis?

Answer 48

Fluid refractory, catecholamine-resistant shock and suspected or proven adrenal insufficiency.

Question 49

What is the hemoglobin target during resuscitation in pediatric sepsis with low ScvO2 (<70%)?

Answer 49

10 g/dL during resuscitation and >7.0 g/dL after stabilization and recovery.

Question 50

What is the recommended glycemic control target in pediatric sepsis?

Answer 50

Control hyperglycemia with a target ≤180 mg/dL. Provide glucose infusion alongside insulin therapy.

Question 51

What is the definition of drowning?

Answer 51

The process of experiencing respiratory impairment from submersion or immersion in liquid.

Question 52

What are the three main pathophysiologies of drowning?

Answer 52

Anoxic-ischemic injury, pulmonary injury, and cold water injury/hypothermia.

Question 53

What are the risk factors for drowning?

Answer 53

Age, male gender, access to water, floodwaters, unsupervised infants, alcohol, medical conditions, unfamiliarity with the place, low socioeconomic status, and rural populations.

Question 54

What is the management priority for a drowning victim?

Answer 54

Focus on airway clearance, oxygenation, ventilation, and restoring circulation. Protect the cervical spine if trauma is suspected.

Question 55

What is the best prognosticator of long-term CNS outcomes in drowning victims?

Answer 55

Neurologic examination and progression during the first 24-72 hours post-submersion.

Question 56

What preventive measures reduce drowning risks?

Answer 56

Learn life-saving skills (swimming), use barriers like fences, enforce life jacket use, and provide vigilant supervision.