Shock
inability to supply O2 for aerobic cellular metabolism
leading to less efficient anaerobic metabolism (brain doesn't have this capacity)
Compensated
Hypotension = <5th centile for age
Most deaths are related to Multiple organ dysfunction syndrome (MODS) rather than the acute affects
Types:
Rx
20ml/kg of Normal Saline or colloid x 2-3 (unless crackles / hepatomegaly)
Fluid resistance shock (L-DOPA>Dopamine>noradrenaline>adrenaline
leading to less efficient anaerobic metabolism (brain doesn't have this capacity)
Compensated
- HR increased, Peripheral vasoconstriction with NORMAL BP
- Hypotensive: organ dysfunction starts to appear
- Irreversible: irreversible end-organ damage
Hypotension = <5th centile for age
- term neonates (0 to 28 days): <60 mmHg
- infants (1 month to 12 months): <70 mmHg
- children 1 to 10 years: <70 mmHg + (2 x age in years)
- children 10 years of age or older: <90 mmHg
Most deaths are related to Multiple organ dysfunction syndrome (MODS) rather than the acute affects
Types:
- Hypovolaemic (reduced preload, responds to fluids)
- Haemorragic (Trauma)
- Class I: <15% (v. mild): Tachy, normal pulses
- Class II: 16-25% (mild): reduced pulses, normal pH
- Class IIII: 26-39% (mod): Acidotic,
- Class IV: 40%+ (severe): Coma
- Gastroenteritis
- mild 3-5, mod 6-9, sev 10
- Haemorragic (Trauma)
- Distributive shock (reduced afterload)
- Sepsis
- Anaphylaxis
- Neurogenic
- Cardiogenic
- CHD
- Myocarditis
- Cardiomyopathy
- Toxicity / poisoning
- Arrhythmias
- Cardiac trauma
- Obstructive
- Tamponade
- Tension
- duct dependent lesions
- PE
Rx
20ml/kg of Normal Saline or colloid x 2-3 (unless crackles / hepatomegaly)
Fluid resistance shock (L-DOPA>Dopamine>noradrenaline>adrenaline
- Cold shock
- Adrenaline (better than Dopamine) (M Starr PAC 2018)
- Warm shock
- Noradrenaline
- No evidence for Hydrocortisone (M Starr PAC 2018)
- ECMO