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Nelson - Emergencies > Shock > Flashcards

Flashcards in Shock Deck (61):
1

T/F The brain lacks the capacity for anaerobic metabolism

T

2

Criteria for cardiovascular dysfunction (MODS)

1) Despite administration of 60cc/kg isotonic fluid IV, decrease in BP <5th percentile for age or SBP <1 SD below normal for age 2) Need for vasoactive drug to maintain BP in normal range OR 2 of the ff: BE >5, lactate >2x upper limit of normal, UO <0.5cc/kg/hr, CRT >5, core to peripheral temp gap >3C

3

Criteria for respiratory dysfunction (MODS)

PaO2/FiO2 ratio <300 in the absence of CHD or pre-existing lung disease OR PaCO2 >20 over baseline OR proven need for >50% FiO2 to maintain O2sat ≥92% OR need for invasive or noninvasive mechanical ventilation

4

Criteria for neurologic dysfunction (MODS)

GCS ≤11 OR acute change in mental status with a decrease in GCS ≥3 points from baseline

5

Criteria for renal dysfunction (MODS)

Crea ≥2x upper limit of normal for age OR 2x increase in baseline value

6

Criteria for hepatic dysfunction (MODS)

TB ≥4mg/dL, ALT 2x upper limit of normal for age

7

Underlying pathophysiologic mechanism leading to distributive shock

State of abnormal vasodilation

8

Definition of pediatric sepsis

1) Suspected or proven infection or a clinical syndrome associated with high probability of infection 2) SIRS

9

Definition of severe sepsis

Sepsis + organ dysfunction

10

Definition of septic shock

Sepsis + cardiovascular organ dysfunction

11

SIRS criteria

2 of 4, 1 of which must be abnormal temp or abnormal WBC count: 1) Core temp >38.5 or <36 2) Tachycardia or persistent bradycardia over 0.5hr in children <1 y/o 3) RR >2SD above normal for age or acute need for mechanical ventilation not related to neuromuscular disease or general anesth 4) Elevated or depressed WBC for age not secondary to chemo OR >10% immature neutrophils

12

Tachycardia in definition of SIRS is qualified as

Mean HR ≥2SD above normal for age in absence of external stimuli, chronic drugs, or painful stimuli OR unexplained persistent elevation over 0.5-4 hours

13

Goals in fluid resuscitation for shock

Normal HR, UO 1cc/kg/hr, CRT <2, improved mental status

14

Smaller boluses of ___ should be given for cardiogenic shock

5-10cc/kg

15

Improves systolic function and decreases SVR without causing a significant increase in HR with added benefit of enhancing diastolic relaxation in cases of cardiogenic shock

Milrinone

16

Inotropes: Vasoconstrictor at high dose, vasodilator at low dose

Dopamine and Epinephrine

17

Inotropes: Potent inotrope, chronotrope, and direct pressor

Epi and Norepi

18

T/F Milrinone has no pressor nor chronotrope activity

T

19

T/F Dobutamine has no pressor activity

T

20

Type of Shock: DM/DI

Hypovolemic

21

Type of Shock: Androgenital syndrome

Hypovolemic

22

Type of Shock: CNS/Spinal injury

Distributive

23

Type of Shock: Drug intoxication

Distributive, cardiogenic

24

Type of Shock: Kawasaki

Cardiogenic

25

Type of Shock: Cardiac tumor

Obstructive

26

Type of Shock: CO poisoning

Dissociative

27

Type of Shock: Methemoglobinemia

Dissociative

28

Breathing pattern: Diseases of decreased lung compliance

Rapid and shallow (decreased tidal volume)

29

Breathing pattern: Obstructive airway diseases

Deep but less rapid (increased tidal volume)

30

Extrathoracic vs intrathoracic airway obstruction: Inspiratory stridor

Extra

31

Extrathoracic vs intrathoracic airway obstruction: Chest wall and subcostal retractions

Extra

32

Extrathoracic vs intrathoracic airway obstruction: Prolongation of expiration

Intra

33

Extrathoracic vs intrathoracic airway obstruction: Expiratory wheeze

Intra

34

Extrathoracic vs intrathoracic airway obstruction: Prolongation of inspiration

Extra

35

T/F Patient's general state, respiratory effort, and potential for impending exhaustion are more important indicators for respiratory failure than blood gas values

T

36

Consensus definition of Acute Lung Injury (ALI)

1) Acute onset (<7 days) 2) Severe hypoxemia (PaO2/FiO2 <300 for ALI, <200 for ARDS) 3) Diffuse bilateral pulmonary infiltrates on frontal radiograph consistent with pulmonary edema 4) Absence of left atrial htn

37

T/F Both ventilation and perfusion are lower in nondependent areas of the lung and higher in dependent areas of the lung

T

38

Venous admixture or incomplete arterialization of systemic venous (pulmonary arterial) blood results from

Perfusion in excess of ventilation

39

Intrapulmonary shunting of systemic venous blood to systemic arterial circulation results from

Perfusion of unventilated areas of the lungs

40

Diffusion defects manifests as hypoxemia vs hypercarbia

Hypoxemia (diffusion capacity of CO@ is 20x greater than that of O2)

41

Formula for an estimation of the FiO2 during use of nasal cannula in older children and adults

FiO2 - 21% (LPM x 2)

42

FiO2 values of a simple mask

0.30-0.65

43

T/F A high flow nasal cannula provides significant CPAP

T

44

Provide PAP during exhalation and additional positive pressure during inspiration

BiPAP

45

Formula for ID or internal diameter of ET tube

Age/4+4

46

Pressure necessary to move a given amount of air into the lung is determined by 2 factors

1) Lung and chest wall elastance 2) Airway resistance

47

2 ventilator strategies commonly employed to improve O2 in diseases with decreased FRC

Application of PEEP and increasing iT

48

What is recruitment

Process of opening atelectatic alveoli

49

Mechvent mode: Inspiration is initiated at a set frequency with a timing mechanism independent of patient effort

SIMV

50

Mechvent mode: Each and every patient breath is triggered by pressure of flow generated by patient inspiratory effort and assisted with either preselected inspiratory pressure or volume

AC

51

Mechvent mode: Machine-delivered volume is the primary control and inflation pressure generated depends on respiratory system's compliance and resistance

Volume-controlled ventilation

52

Mechvent mode: Pressure change above baseline is primary control, and the TV delivered to the lungs depends on respiratory system's compliance and resistance

Pressure-controlled ventilation

53

Most useful expiratory maneuver in mechanical ventilation

Application of PEEP

54

Most important clinical benefits of PEEP

Recruitment of alveoli AND increasing FRC

55

iTime is usually initiated at ___ for neonates, ___ for older children, and ___ for adolescents and adults

0.5-0.7 sec, 0.8-1, 1-1.2

56

In patients with severe acute hypoxemic respiratory failure, avoidance of TV ___ limits diffuse alveolar damage

≥10cc/kg

57

Most effective strategy to minimize ventilator associated pneumonia

Regular assessment of extubation readiness and liberation from mech vent as soon as clinically possible

58

Most objective means of assessing extubation readiness

Spontaneous breathing trial (SBT): CPAP with minimal or no pressure support with no episodes of respiratory or cardiovascular decompensation

59

Populations at increased risk for extubation failure

1) Young infants 2) Mechanically ventilated >7 days 3) Chronic respiratory or neurologic conditions

60

MCC of extubation failure in children

Post extubation upper airway obstruction

61

Minimizes incidence of postextubation airway obstruction

IV corticosteroids, e.g. Dexa 0.5mg/kg q6 for 4 doses prior to extubation