Shock Flashcards

1
Q

What is shock?

A

Where the circulation is inadequate to meet the metabolic demands of the tissues

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2
Q

Who is shock common in?

A

Critically ill children

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3
Q

Is shock caused by one thing?

A

No - there are varied reasons

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4
Q

How does the fluid intake requirement per kg of body weight in children compare to adults?

A

It is much higher

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5
Q

Why is the fluid intake requirement per kg of body weight in children higher than in adults?

A
  • Higher surface area-to-volume ratio

- Higher basal metabolic rate

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6
Q

What factors may cause a child to become dehydrated?

A
  • Unable to take oral fluids
  • Additional loss of fluids
  • Loss of fluid retaining mechanisms
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7
Q

What can cause inability to take oral fluids?

A
  • Decreased consciousness

- Vomiting

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8
Q

What can cause additional fluid losses?

A
  • Diarrhoea
  • Fever
  • Increased sweating
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9
Q

What can cause loss of normal fluid retention mechanisms?

A
  • Burns
  • Increased urinary loss
  • Capillary leak
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10
Q

How can blood pressure be maintained in early shock?

A
  • Increase HR
  • Increased RR
  • Diversion of blood flow from non-essential tissues to vital organs
  • Redistribution of blood from venous reserve volume
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11
Q

What happens in late shock?

A

Compensatory mechanisms fail, BP falls and lactic acidosis increases

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12
Q

Why is it important to recognise early compensated shock?

A

It can be reversible, decompensated shock may not be

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13
Q

What are the different categories of shock?

A
  • Hypovolaemic
  • Distributive
  • Cardiogenic
  • Neurogenic
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14
Q

What can cause hypovolaemic shock?

A
  • Haemorrhage
  • Dehydration e.g. vomiting
  • Burns
  • Diabetic ketoacidosis
  • Sepsis
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15
Q

What can cause distributive shock?

A
  • Sepsis

- Anaphylaxis

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16
Q

What can cause cardiogenic shock?

A
  • Arrhythmias

- Heart failure

17
Q

What can cause neurogenic shock?

A

Spinal cord injury

18
Q

What are the risk factors for shock?

A
  • Pre-existing dehydration

- Pre-existing heart disease

19
Q

What causes the symptoms of shock?

A
  • Compensatory physiological changes

- Poor perfusion to tissues

20
Q

What are the symptoms of early, compensated shock?

A
  • Tachycardia
  • Tachypnoea
  • Decreased skin turgor
  • Sunken eyes and fontanelles
  • Delayed cap refill
  • Mottled, pale, cold skin
  • Core-peripheral temperature gap > 4 degrees
  • Decreased urine output
21
Q

What are the symptoms of late, decompensated shock?

A
  • Acidotic breathing
  • Bradycardia
  • Confusion
  • Blue peripheries
  • Absent urine output
  • Hypotension
22
Q

What investigations should be performed in suspected shock?

A
  • ABG including lactate
  • FBC
  • Urea and creatinine
23
Q

What are the differentials for shock?

A
  • Simple hypotension

- Syncope or pre-syncope

24
Q

What is the priority for management of shock?

A

Rapid restoration of intravascular circulatin volume with IV fluid resuscitation

25
Q

What fluids are normally given in fluid resuscitation in shock?

A
  • 0.9% saline

- Blood (if due to haemorrhage)

26
Q

What should be given following replacement of fluid deficit?

A

Maintenance fluids

27
Q

How are maintenance fluids calculated for children?

A
  • For first 10kg = 100ml/kg/24 hours
  • For second 10kg = 50ml/kg/24 hours
  • For subsequent kg’s = 20ml/kg/24 hours
28
Q

If there is no improvement following fluid resuscitation or there is progression or respiratory failure who should be contacted?

A

PICU

29
Q

What may a child need for shock in PICU?

A
  • Tracheal intubation
  • Mechanical ventilation
  • Invasive BP monitoring
  • Ionotropic support
  • Correction of haematological, biochemical and metabolic derangements
  • Support of renal failure
30
Q

What are the potential complications of shock?

A
  • Multiple organ dysfunction
  • End-organ damage
  • Death