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24 Cards in this Set
- Front
- Back
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What is shock
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inadequate perfusion to meet metabolic demands of tissues
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What is the BP with a patient who is shocky
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BP can be high or low
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What is the assessment of shock
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1.HR
2. RR 3. Peripheral compared to central pulses 4. Skin perfusion 5. CNS perfusion (GCS) 6. BP |
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What is compensated shock
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Normal BP but perfusion does not meet tissues demand needs
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What is the lower limit of normal for systolic blood pressure of 0-1 month, 1 month -1 year, > 1 year
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0-1 month : 60 systolic
1 month - 1 year: 70 systolic > 1 year: 70 + (2 X age in years) |
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How do you approach a compensated shock peds patient
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1. ABC
2. High O2 3. Monitor O2 and HR 4. Achieve Vascular access |
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Should you ever withhold high oxygen out of concern about oxygen toxicity and depressing respiration when a child is in shock
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NO
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Is the pulse oximetry reliable when a child is in shock
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No, until perfusion is restored
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How do you approach vascular access in a peds patient with decompensated shock
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Limit the attempt at peripheral vascular access to less than 90 seconds or 3 attempts
Can attempt intraoseous access or central line |
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How much fluid should you give a kid
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20 ml/kg
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What type of fluid should be given
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1. Crystalloid (first line)
2. Maybe colloid but risk of reaction, infection, DIC 3. Blood especially 3rd bolus of crystalloid is given |
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Why do you not give a kid 5% dextrose
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5% dextrose has 5m/100 mL therefore 1g/20ml, this is very high and would cause osmotic diuresis, hyperglycaemia
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How do you treat hypoglycaemia to a peds patient
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0.5 g/kg glucose as separate bolus
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What supplementary assessment Studies could be performed
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1. Urin output (1-2 ml/kg/hr)
2. ABG 3. Chest X-ray Large heart give inotrope Small heart = hypovolemic therefore need more fluid |
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How do you treat acute metabolic acidosis caused by dehydration
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Treat the underlying cause
Volume if hypovolemic Inotropes if perfusion still poor after fluid (Using bicarb is controversial can make acidosis worse) |
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When do you absolutely intubate
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Loss of airway (because loss of consciousness)
Hypoxia |
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What are the advantages of intubating in shock
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1. Max FiO2
2. Decrease work of breathing 3. Can control hyperventilation (incase metabolic acidosis) 4. Can control airway |
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What is respiratory distress
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Increased work of breathing
Near normal vital signs |
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What is respiratory failure
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Inadequate oxygenation or ventilation that may occur with or without respiratory distress
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What does potential Respiratory Failure Look like
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1. Air way potency (stridor, croup, wheeze)
2. RR = accessory muscle, nasal flaring 3. Level of consciousness (slow) |
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What is the approach to a patient with potential respiratory failure
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1. Open airway and assist ventilation
2. Administer O2 carefully 3. Monitor (HR, RR, pulse ox) 4. Get ABG, Lytes, Chest x-ray (for foreign body) |
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When you intubate an infant what must you do immediately
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Confirm endotrhaceal tube position
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How do you confirm and endotracheal tube position
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1. Auscultate (Axilla, base, apex0
2. End tidal CO2 3. Ches x-ray 4. Tape down the tube |
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What are the causes of deterioration of an intubated patient
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DOPE
Displaced tube (most common) Obstructed tube Pneumothorax or other air leak Equipment problems |
