95988 633598102111718750
-
Upload
oliyad-tashaaethiopia -
Category
Health & Medicine
-
view
128 -
download
0
description
Transcript of 95988 633598102111718750
![Page 1: 95988 633598102111718750](https://reader036.fdocuments.in/reader036/viewer/2022081519/555d63cdd8b42a0b778b4662/html5/thumbnails/1.jpg)
Pediatric Shock and
Disorders of Hydration
![Page 2: 95988 633598102111718750](https://reader036.fdocuments.in/reader036/viewer/2022081519/555d63cdd8b42a0b778b4662/html5/thumbnails/2.jpg)
Shock
Inadequate peripheral perfusion where oxygen delivery does not
meet metabolic demand
![Page 3: 95988 633598102111718750](https://reader036.fdocuments.in/reader036/viewer/2022081519/555d63cdd8b42a0b778b4662/html5/thumbnails/3.jpg)
Adult vs Pediatric Shock
Same causes/different frequencies
![Page 4: 95988 633598102111718750](https://reader036.fdocuments.in/reader036/viewer/2022081519/555d63cdd8b42a0b778b4662/html5/thumbnails/4.jpg)
Adult vs Pediatric Shock
• Hypovolemia– Most common cause of pediatric shock– Small blood volumes (80cc/kg)
![Page 5: 95988 633598102111718750](https://reader036.fdocuments.in/reader036/viewer/2022081519/555d63cdd8b42a0b778b4662/html5/thumbnails/5.jpg)
Adult vs Pediatric Shock
• Sepsis– Second most common cause of
pediatric shock– Immature immune system
![Page 6: 95988 633598102111718750](https://reader036.fdocuments.in/reader036/viewer/2022081519/555d63cdd8b42a0b778b4662/html5/thumbnails/6.jpg)
Adult vs Pediatric Shock
• Cardiogenic– Primary pump failure rare– Secondary failure from:
• Hypoxia• Acidosis• Hypoglycemia• Hypothermia• Drug toxicity
![Page 7: 95988 633598102111718750](https://reader036.fdocuments.in/reader036/viewer/2022081519/555d63cdd8b42a0b778b4662/html5/thumbnails/7.jpg)
Adult vs Pediatric Shock
• Neurogenic– Rare– Low incidence associated with low
pediatric spinal cord trauma rates
![Page 8: 95988 633598102111718750](https://reader036.fdocuments.in/reader036/viewer/2022081519/555d63cdd8b42a0b778b4662/html5/thumbnails/8.jpg)
Adult vs Pediatric Shock
• Hypoglycemia– Mimics shock– Altered level of consciousness– Pallor– Tachycardia– Diaphoresis
![Page 9: 95988 633598102111718750](https://reader036.fdocuments.in/reader036/viewer/2022081519/555d63cdd8b42a0b778b4662/html5/thumbnails/9.jpg)
Pediatric Shock
• Early shock - Very difficult to detect
• Pediatric cardiovascular system compensates well
![Page 10: 95988 633598102111718750](https://reader036.fdocuments.in/reader036/viewer/2022081519/555d63cdd8b42a0b778b4662/html5/thumbnails/10.jpg)
Pediatric Shock
• Early Signs/Symptoms– Tachycardia - carry chart of normals– Slow capillary refill ( > 2 seconds)– Pale or mottled skin, cool extremities– Tachypnea
![Page 11: 95988 633598102111718750](https://reader036.fdocuments.in/reader036/viewer/2022081519/555d63cdd8b42a0b778b4662/html5/thumbnails/11.jpg)
Pediatric Shock
• Late Signs/Symptoms– Weak or absent peripheral pulses– Decreasing level of consciousness– Hypotension
![Page 12: 95988 633598102111718750](https://reader036.fdocuments.in/reader036/viewer/2022081519/555d63cdd8b42a0b778b4662/html5/thumbnails/12.jpg)
Pediatric Shock
Hypotension = Late Sign of Shock
Pre-arrest State
![Page 13: 95988 633598102111718750](https://reader036.fdocuments.in/reader036/viewer/2022081519/555d63cdd8b42a0b778b4662/html5/thumbnails/13.jpg)
Pediatric Shock
Reassess, Reassess, ReassessPediatric patients in
compensated shock “crash” quickly
![Page 14: 95988 633598102111718750](https://reader036.fdocuments.in/reader036/viewer/2022081519/555d63cdd8b42a0b778b4662/html5/thumbnails/14.jpg)
Pediatric Shock
• Initial assessment may detect shock, but not its cause
• When in doubt, treat for hypovolemia
![Page 15: 95988 633598102111718750](https://reader036.fdocuments.in/reader036/viewer/2022081519/555d63cdd8b42a0b778b4662/html5/thumbnails/15.jpg)
Shock Management
• Airway– Open, clear, maintain– Non-invasive (chin lift, jaw thrust)– Invasive (endotracheal intubation)– Trauma patient - ? C-spine injury
![Page 16: 95988 633598102111718750](https://reader036.fdocuments.in/reader036/viewer/2022081519/555d63cdd8b42a0b778b4662/html5/thumbnails/16.jpg)
Shock Management
• Breathing– 100% oxygen indicated for all shock– Ventilation
• Reduce work of breathing• Do not “fight” patient
![Page 17: 95988 633598102111718750](https://reader036.fdocuments.in/reader036/viewer/2022081519/555d63cdd8b42a0b778b4662/html5/thumbnails/17.jpg)
Shock Management
• Circulation– Apply cardiac monitor– Control obvious hemorrhage– Elevate lower extremities– Do not inflate MAST abdomen if < 10
![Page 18: 95988 633598102111718750](https://reader036.fdocuments.in/reader036/viewer/2022081519/555d63cdd8b42a0b778b4662/html5/thumbnails/18.jpg)
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
![Page 19: 95988 633598102111718750](https://reader036.fdocuments.in/reader036/viewer/2022081519/555d63cdd8b42a0b778b4662/html5/thumbnails/19.jpg)
Shock Management
• Check blood glucose– Give D25W if D-stick < 40 - 60 mg %– Do NOT use D50W in children
![Page 20: 95988 633598102111718750](https://reader036.fdocuments.in/reader036/viewer/2022081519/555d63cdd8b42a0b778b4662/html5/thumbnails/20.jpg)
Cardiac Arrest/Arrhythmias
• Pedi cardiac arrest– Usually complication of respiratory
failure– NOT primary cardiac disease
![Page 21: 95988 633598102111718750](https://reader036.fdocuments.in/reader036/viewer/2022081519/555d63cdd8b42a0b778b4662/html5/thumbnails/21.jpg)
Arrhythmias
– Sinus Tachycardia• Usually physiologic response to non-
cardiac problem– Hypovolemia– Fear– Pain– Fever
• Find, correct underlying problem
![Page 22: 95988 633598102111718750](https://reader036.fdocuments.in/reader036/viewer/2022081519/555d63cdd8b42a0b778b4662/html5/thumbnails/22.jpg)
Arrhythmias
– Bradycardia• Physiologic response to hypoxia• Treat with:
– Oxygenation– Ventilation
• Epinephrine may be useful in stimulating depressed myocardium
• Atropine usually unnecessary
![Page 23: 95988 633598102111718750](https://reader036.fdocuments.in/reader036/viewer/2022081519/555d63cdd8b42a0b778b4662/html5/thumbnails/23.jpg)
Arrhythmias
• Ventricular arrhythmias– Very rare– Imply drug toxicity, electrolyte problems
![Page 24: 95988 633598102111718750](https://reader036.fdocuments.in/reader036/viewer/2022081519/555d63cdd8b42a0b778b4662/html5/thumbnails/24.jpg)
Congenital Heart Disease
• Know your patient population
• Get good history from parents:– Baseline status– Cyanosis– Medications– Surgical history
![Page 25: 95988 633598102111718750](https://reader036.fdocuments.in/reader036/viewer/2022081519/555d63cdd8b42a0b778b4662/html5/thumbnails/25.jpg)
Congenital Heart Disease
• Signs/Symptoms– Poor feeding– Decreased oral intake– Sweating during feeding– Tachypnea– Rales/wheezing– Weak pulses, mottled extremities
![Page 26: 95988 633598102111718750](https://reader036.fdocuments.in/reader036/viewer/2022081519/555d63cdd8b42a0b778b4662/html5/thumbnails/26.jpg)
Congenital Heart Disease
• Management– 100% oxygen
• May not relieve cyanosis– Assist ventilation if respiratory distress
present– Limit fluids
![Page 27: 95988 633598102111718750](https://reader036.fdocuments.in/reader036/viewer/2022081519/555d63cdd8b42a0b778b4662/html5/thumbnails/27.jpg)
Congenital Heart Disease
• Management– Cardiac monitor
• Conduction disorders/bizarre arrhythmias
–Possible digitalis toxicity–Electrolyte imbalances
– Avoid pharmacologic intervention except on medical control orders
![Page 28: 95988 633598102111718750](https://reader036.fdocuments.in/reader036/viewer/2022081519/555d63cdd8b42a0b778b4662/html5/thumbnails/28.jpg)
Disorders of Hydration
![Page 29: 95988 633598102111718750](https://reader036.fdocuments.in/reader036/viewer/2022081519/555d63cdd8b42a0b778b4662/html5/thumbnails/29.jpg)
Disorders of Hydration
• Causes– Vomiting– Diarrhea– Fever– Poor oral intake– Diabetes mellitus
![Page 30: 95988 633598102111718750](https://reader036.fdocuments.in/reader036/viewer/2022081519/555d63cdd8b42a0b778b4662/html5/thumbnails/30.jpg)
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
![Page 31: 95988 633598102111718750](https://reader036.fdocuments.in/reader036/viewer/2022081519/555d63cdd8b42a0b778b4662/html5/thumbnails/31.jpg)
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
![Page 32: 95988 633598102111718750](https://reader036.fdocuments.in/reader036/viewer/2022081519/555d63cdd8b42a0b778b4662/html5/thumbnails/32.jpg)
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
![Page 33: 95988 633598102111718750](https://reader036.fdocuments.in/reader036/viewer/2022081519/555d63cdd8b42a0b778b4662/html5/thumbnails/33.jpg)
Hypotension
Late Sign of Shock
Impending Cardiovascular Collapse
![Page 34: 95988 633598102111718750](https://reader036.fdocuments.in/reader036/viewer/2022081519/555d63cdd8b42a0b778b4662/html5/thumbnails/34.jpg)
Disorders of Hydration
• Management– Oxygen– 20 cc/kg boluses LR– Repeat boluses as needed to
• Restore peripheral pulses• Decrease tachycardia• Improve LOC
![Page 35: 95988 633598102111718750](https://reader036.fdocuments.in/reader036/viewer/2022081519/555d63cdd8b42a0b778b4662/html5/thumbnails/35.jpg)
Disorders of Hydration
• Management– Monitor for:
• Respiratory distress• Pulmonary edema
– Reassess, Reassess, Reassess