shock instr 20sep15.ppt

8/17/2019 SHOCK INSTR 20SEP15.ppt

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Major Sponsor Paediatric BASICPaediatric BASIC

Shock


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Paediatric BASICPaediatric BASIC Major Sponsor

Shock

Oxygen delivery does not meet oxygenconsumption/demandOxygen utilization may be impaired atmitochondrial levelMay be normotensive


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Differences BetweenChildren and Adults

Shock in children:Vasodilatory shock less common

Hypotension is a late featureo! absolute circulating volume

"O is more heart rate #not SV$ dependentVascular access can be difficult


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Signs of Shock

"onscious state % restless anxious agitatedSkin % mottled& cool& !arm"apillary refill time prolonged'achycardia'achypnoeaOliguria

(lood pressure % poor pulse pressure or !idepulse pressure


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Severity of shock

)nciting in*ury+apidity and extent of volume loss,ormotensive does not mean ade-uateoxygen delivery.egree of compensation


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Types of ShockH+ V0 or "V0 0eripheries

Hypovolemic↑ down "old

+arely 1arm

"ardiogenic ↑ Or

downup

"oldObstructive2 ↑ ↑↑ "old

.istributive22 Variable Variable

*Obstructive shock due to cardiac tamponade& tension pneumothorax or massive pulm embolus22.istributive Shock eg 3naphylactic/,eurogenic

Septic Shock can have elements of all of the above


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Paediatric BASICPaediatric BASICMajor Sponsor

Neonate with Shock

"onsider duct dependent congenital heart lesions inpersistent shock in any neonate

%Start 0rostaglandin 45 #064$"onsider a metabolic diagnosis#)4M$ in the context ofhypoglycaemia& severe acidosis& seizures& liverfailure


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Shock - Resuscitation

7luid % isotonic solutions #e8g8 98 ; Saline$Size of fluid bolus % depends on type of shock

Hypovolaemic %


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Su!!ary

6oal of 'reatment+estore oxygen deliveryto tissues.O < ? "O x Hb x SaO <

3ssessment of "O"onscious stateSkin perfusion@rine output

SvO<actate

'reatment)ntravenous fluid)notrope #Vvasoconstrictor$ ifindicated

'itrate against patientresponse'reat cause3ntibiotics

0rostaglandin for persistentcyanosis in neonates

shock instr 20sep15.ppt

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