Pediatric Boards Xxx.) Critical Care

Front 1

What is shock?

Back 1

when not enough O2 and nutrients meet tissue metabolic demand; sometimes, but not always when there is inadequate peripheral and end-organ perfusion

Front 2

What blood pressure and cardiac output is associated with shock?

Back 2

all can be, normal, increased, decreased; cardiac output is usually low, but can be high

Front 3

Define the four types of shock, hypovolemic, cardiogenic, distributive, and obstructive

Back 3

1.) hypovolemic: not enough blood volume or oxygen-
carrying capacity
3.) inappropriate distribution of blood volume and flow
2.) impaired cardiac contractility
4.) obstructed blood flow

Front 4

What is the pathophysiology of shock?

Back 4

When O2 delivery is not enough to meet tissue demand, cells will use anaerobic metabolism for energy, making lactic acid as a by-product, which can only keep a cell going for so long, so if O2 delivery is not reinstilled organ failure occurs

Front 5

What is the formula for cardiac output?

Back 5

stroke vol(volume of blood pumped per beat) X HR(beats/min)

Front 6

Why are infants dependent on an adequate HR?

Back 6

because they're stroke volume is so small that HR must be higher to maintain the necessary CO; as the child develops, the heart is more able to increase stroke volume

Front 7

What is adequate distribution dependent on?

Back 7

size of blood vessels since each determines the vascular resistance

Front 8

What is the most common cause of low cardiac output?

Back 8

low stroke volume, or inadequate preload which can lead to hypovolemic shock

Front 9

What is the cause of cardiogenic shock?

Back 9

"of the heart" meaning that muscle of the heart is the issue...so most commonly, poor contractility, less commonly, increased afterload

Front 10

What is the main method of treating cardiogenic shock?

Back 10

reducing afterload because it essentially reduces CO, which then causes blood vessels to vasoconstrict to maintain adequate blood flow to organs, all the while causing resistance to output

Front 11

What are the four compensatory mechanisms of shock that occur in order and what is the physiology behind them?

Back 11

1.) tachycardia- initially HR increases to maintain CO, but eventually SV cant keep up, so perfusion of tissues is compromised
2.) increase SVR- selective vasoconstriction happens to divert blood to vital organs causing a decrease in peripheral perfusion and to the gut and kidneys so as to decrease urine output
3/4.) Contractility increases so ventricles completely empty, also venous blood return increases to increase preload and improving venous return to the heart

Front 12

What is the formula for blood pressure?

Back 12

Cardiac Output(CO) x SVR

Front 13

How is blood pressure effected in children?

Back 13

SVR increases when CO decreases so BP actually stays normal, initially

Front 14

What is pulse pressure and what happens during shock in kids?

Back 14

difference between systolic and diastolic BP that is usually narrowed because SVR increases diastolic blood pressure; if SVR is low, then pulse pressure widens

Front 15

What is the most common tachyarrythmia that causes cardiovascular compromise during pregnancy?

Back 15

SVT, because it starts and stops randomly

Front 16

What are effects that SVT has on ABCDE?

Back 16

A.) nothing
B.) Tachypnea, increased work of breathing, crackles and grunting if CHF
C.) Tachy, delayed cap refill, weak peripheral pulses, cool ext, , diaphortic, hypotension, JVD
D.) AMS, lethargy, irratibility
E.) check temp last