Shock

Question 1

What is shock?

Answer 1

Where the circulation is inadequate to meet the metabolic demands of the tissues

Question 2

Who is shock common in?

Answer 2

Critically ill children

Question 3

Is shock caused by one thing?

Answer 3

No - there are varied reasons

Question 4

How does the fluid intake requirement per kg of body weight in children compare to adults?

Answer 4

It is much higher

Question 5

Why is the fluid intake requirement per kg of body weight in children higher than in adults?

Answer 5

• Higher surface area-to-volume ratio

- Higher basal metabolic rate

Question 6

What factors may cause a child to become dehydrated?

Answer 6

• Unable to take oral fluids
• Additional loss of fluids
• Loss of fluid retaining mechanisms

Question 7

What can cause inability to take oral fluids?

Answer 7

• Decreased consciousness

- Vomiting

Question 8

What can cause additional fluid losses?

Answer 8

• Diarrhoea
• Fever
• Increased sweating

Question 9

What can cause loss of normal fluid retention mechanisms?

Answer 9

• Burns
• Increased urinary loss
• Capillary leak

Question 10

How can blood pressure be maintained in early shock?

Answer 10

• Increase HR
• Increased RR
• Diversion of blood flow from non-essential tissues to vital organs
• Redistribution of blood from venous reserve volume

Question 11

What happens in late shock?

Answer 11

Compensatory mechanisms fail, BP falls and lactic acidosis increases

Question 12

Why is it important to recognise early compensated shock?

Answer 12

It can be reversible, decompensated shock may not be

Question 13

What are the different categories of shock?

Answer 13

• Hypovolaemic
• Distributive
• Cardiogenic
• Neurogenic

Question 14

What can cause hypovolaemic shock?

Answer 14

• Haemorrhage
• Dehydration e.g. vomiting
• Burns
• Diabetic ketoacidosis
• Sepsis

Question 15

What can cause distributive shock?

Answer 15

• Sepsis

- Anaphylaxis

Question 16

What can cause cardiogenic shock?

Answer 16

• Arrhythmias

- Heart failure

Question 17

What can cause neurogenic shock?

Answer 17

Spinal cord injury

Question 18

What are the risk factors for shock?

Answer 18

• Pre-existing dehydration

- Pre-existing heart disease

Question 19

What causes the symptoms of shock?

Answer 19

• Compensatory physiological changes

- Poor perfusion to tissues

Question 20

What are the symptoms of early, compensated shock?

Answer 20

• Tachycardia
• Tachypnoea
• Decreased skin turgor
• Sunken eyes and fontanelles
• Delayed cap refill
• Mottled, pale, cold skin
• Core-peripheral temperature gap > 4 degrees
• Decreased urine output

Question 21

What are the symptoms of late, decompensated shock?

Answer 21

• Acidotic breathing
• Bradycardia
• Confusion
• Blue peripheries
• Absent urine output
• Hypotension

Question 22

What investigations should be performed in suspected shock?

Answer 22

• ABG including lactate
• FBC
• Urea and creatinine

Question 23

What are the differentials for shock?

Answer 23

• Simple hypotension

- Syncope or pre-syncope

Question 24

What is the priority for management of shock?

Answer 24

Rapid restoration of intravascular circulatin volume with IV fluid resuscitation

Question 25

What fluids are normally given in fluid resuscitation in shock?

Answer 25

- 0.9% saline | - Blood (if due to haemorrhage)

Question 26

What should be given following replacement of fluid deficit?

Answer 26

Maintenance fluids

Question 27

How are maintenance fluids calculated for children?

Answer 27

- For first 10kg = 100ml/kg/24 hours - For second 10kg = 50ml/kg/24 hours - For subsequent kg's = 20ml/kg/24 hours

Question 28

If there is no improvement following fluid resuscitation or there is progression or respiratory failure who should be contacted?

Answer 28

PICU

Question 29

What may a child need for shock in PICU?

Answer 29

- Tracheal intubation - Mechanical ventilation - Invasive BP monitoring - Ionotropic support - Correction of haematological, biochemical and metabolic derangements - Support of renal failure

Question 30

What are the potential complications of shock?

Answer 30

- Multiple organ dysfunction - End-organ damage - Death