Shock Flashcard 2

B. Rationale: The patient should be given epinephrine. Fluid-refractory septic shock is defined as persistent shock despite receiving 40–60 mL/kg of IV fluid resuscitation for 1 hour. From the PALS guidelines, epinephrine or nor epinephrine should be considered as an additional next step in the treatment of fluid-refractory shock.

C. Rationale: In distributive shock, cardiac output is increased or normal, but systemic vascular resistance is decreased in these patients due to good stroke volume, especially after fluid therapy. In contrast to other types of shock where there is low cardiac output but increased systemic vascular resistance, the cardiac output is maintained in distributive shock by a compensatory tachycardia and increased ventricular end-diastolic volume.

B. Rationale: Pericardiocentesis is the treatment of choice for cardiac tamponade. Most patients have good outcomes if cardiac tamponade is rapidly diagnosed and treated. While the patient is being prepared for pericardiocentesis, IV fluid administration with an isotonic crystalloid solution can help improve cardiac output and tissue perfusion. The provider must seek a consultant with experience in performing pericardiocentesis. Cricothyroidotomy is used in patients with complete upper airway obstruction. Closed-tube thoracostomy is performed in patients with tension pneumothorax. Furosemide therapy is recommended in the relief of congestive heart failure.

B. Rationale: Stroke volume is affected by preload, myocardial contractility, and afterload. The most common cause of cardiogenic shock is inadequate preload. Preload is the volume of blood in the ventricles during end-diastole.

A. Rationale: A fundamental aspect of shock that providers must know is that blood pressure can be normal or even slightly increased in pediatric shock. If systemic vascular resistance is severely increased in patients in compensated shock, blood flow through the peripheral arteries will be compromised. Poor peripheral pulses in a pediatric patient in shock with a normal blood pressure signifies that blood flow to the tissues is likely compromised. Blood pressure measurement in areas with diminished peripheral pulses may be unreliable. Care should be taken since this may delay recognition of declining blood pressure as the patient transitions to uncompensated shock and impending cardiopulmonary failure.

A. Rationale: Shock in pediatric patients with medical conditions that significantly restrict the pumping motion of the heart or the entry or exit of blood through the heart is categorized as obstructive shock. This can be caused by cardiac tamponade, pneumothorax, congenital heart defects, or a massive pulmonary embolism.

B. Rationale: The patient presents with septic shock, which is a direct sequela of sepsis. The cornerstone treatment for patients in shock is the rapid administration of isotonic fluids.

D. Rationale: Immediate recognition of respiratory failure and shock is necessary for the successful prevention and treatment of cardiac arrest. In this instance, the patient is not in cardiac arrest but anaphylactic shock as evidenced by hypotension, generalized body edema, tachycardia, central cyanosis, and tachypnea, which all represent poor tissue perfusion. Anaphylactic shock causes vasodilatation and extravasation of fluids into the tissues (third-spacing). Inadequate intravascular volume significantly affects tissue perfusion. After diagnosing anaphylactic shock and treating for respiratory compromise, immediate fluid resuscitation will prevent disease progression to cardiopulmonary failure.

C. Rationale: Afterload is affected by systemic vascular resistance. Afterload is increased if there is an increase in systemic vascular resistance and decreased when there is a decrease in SVR.

D. Rationale: Obstructive shock can be caused by the following disease conditions: massive pulmonary embolism, ductal-dependent congenital heart defects, tension pneumothorax, and pericardial tamponade. These hinder cardiac motion, cause mechanical obstruction to blood flow, or restrict venous return. A massive pulmonary embolism can occur after orthopedic surgery if a large bone releases fat into the bloodstream or when a thrombus is formed in the immobilized limb due to poor circulation, dislodges, and wedges into the pulmonary vasculature.