Pediatric shock

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Information about Pediatric shock
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Published on October 16, 2008

Author: aSGuest1139

Source: authorstream.com

Pediatric Shock and Disorders of Hydration : Pediatric Shock and Disorders of Hydration Shock : Shock Inadequate peripheral perfusion where oxygen delivery does not meet metabolic demand Adult vs Pediatric Shock : Adult vs Pediatric Shock Same causes/different frequencies Adult vs Pediatric Shock : Adult vs Pediatric Shock Hypovolemia Most common cause of pediatric shock Small blood volumes (80cc/kg) Adult vs Pediatric Shock : Adult vs Pediatric Shock Sepsis Second most common cause of pediatric shock Immature immune system Adult vs Pediatric Shock : Adult vs Pediatric Shock Cardiogenic Primary pump failure rare Secondary failure from: Hypoxia Acidosis Hypoglycemia Hypothermia Drug toxicity Adult vs Pediatric Shock : Adult vs Pediatric Shock Neurogenic Rare Low incidence associated with low pediatric spinal cord trauma rates Adult vs Pediatric Shock : Adult vs Pediatric Shock Hypoglycemia Mimics shock Altered level of consciousness Pallor Tachycardia Diaphoresis Pediatric Shock : Pediatric Shock Early shock - Very difficult to detect Pediatric cardiovascular system compensates well Pediatric Shock : Pediatric Shock Early Signs/Symptoms Tachycardia - carry chart of normals Slow capillary refill ( > 2 seconds) Pale or mottled skin, cool extremities Tachypnea Pediatric Shock : Pediatric Shock Late Signs/Symptoms Weak or absent peripheral pulses Decreasing level of consciousness Hypotension Pediatric Shock : Pediatric Shock Hypotension = Late Sign of Shock Pre-arrest State Pediatric Shock : Pediatric Shock Reassess, Reassess, Reassess Pediatric patients in compensated shock “crash” quickly Pediatric Shock : Pediatric Shock Initial assessment may detect shock, but not its cause When in doubt, treat for hypovolemia Shock Management : Shock Management Airway Open, clear, maintain Non-invasive (chin lift, jaw thrust) Invasive (endotracheal intubation) Trauma patient - ? C-spine injury Shock Management : Shock Management Breathing 100% oxygen indicated for all shock Ventilation Reduce work of breathing Do not “fight” patient Shock Management : Shock Management Circulation Apply cardiac monitor Control obvious hemorrhage Elevate lower extremities Do not inflate MAST abdomen if < 10 Shock Management : Shock Management Fluid Resuscitation Consider scene time Consider intraosseous access Fluid bolus: 20 cc/kg Most common error--Too LITTLE fluid Reassess for: Improved perfusion Respiratory distress Shock Management : Shock Management Check blood glucose Give D25W if D-stick < 40 - 60 mg % Do NOT use D50W in children Cardiac Arrest/Arrhythmias : Cardiac Arrest/Arrhythmias Pedi cardiac arrest Usually complication of respiratory failure NOT primary cardiac disease Arrhythmias : Arrhythmias Sinus Tachycardia Usually physiologic response to non-cardiac problem Hypovolemia Fear Pain Fever Find, correct underlying problem Arrhythmias : Arrhythmias Bradycardia Physiologic response to hypoxia Treat with: Oxygenation Ventilation Epinephrine may be useful in stimulating depressed myocardium Atropine usually unnecessary Arrhythmias : Arrhythmias Ventricular arrhythmias Very rare Imply drug toxicity, electrolyte problems Congenital Heart Disease : Congenital Heart Disease Know your patient population Get good history from parents: Baseline status Cyanosis Medications Surgical history Congenital Heart Disease : Congenital Heart Disease Signs/Symptoms Poor feeding Decreased oral intake Sweating during feeding Tachypnea Rales/wheezing Weak pulses, mottled extremities Congenital Heart Disease : Congenital Heart Disease Management 100% oxygen May not relieve cyanosis Assist ventilation if respiratory distress present Limit fluids Congenital Heart Disease : Congenital Heart Disease Management Cardiac monitor Conduction disorders/bizarre arrhythmias Possible digitalis toxicity Electrolyte imbalances Avoid pharmacologic intervention except on medical control orders Disorders of Hydration : Disorders of Hydration Disorders of Hydration : Disorders of Hydration Causes Vomiting Diarrhea Fever Poor oral intake Diabetes mellitus Disorders of Hydration : Disorders of Hydration Mild dehydration ( <5% weight loss) Mild increased thirst Slight mucous membrane dryness Slight decrease in urinary frequency Slight increase in pulse rate Disorders of Hydration : Disorders of Hydration Moderate dehydration (5 - 10% weight loss) Moderate increase in thirst Very dry, “beefy red” mucous membranes Decrease in skin turgor Tachycardia Oliguria, concentrated urine Sunken eyes Disorders of Hydration : Disorders of Hydration Severe dehydration (10 - 15% weight loss) Severe thirst Tenting of skin No tears when crying Weak, thready pulses Marked tachycardia Sunken fontanelle Hypotension Decrease in LOC Hypotension : Hypotension Late Sign of Shock Impending Cardiovascular Collapse Disorders of Hydration : Disorders of Hydration Management Oxygen 20 cc/kg boluses LR Repeat boluses as needed to Restore peripheral pulses Decrease tachycardia Improve LOC Disorders of Hydration : Disorders of Hydration Management Monitor for: Respiratory distress Pulmonary edema Reassess, Reassess, Reassess

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