Location via proxy:   [ UP ]  
[Report a bug]   [Manage cookies]                
Scribd Logo
Upload

Welcome to Scribd!

  • 51 views

    Shock and Management

    Uploaded by

    raffepunzel
    1) Acute hypovolemia, or a loss of fluid from the intravascular space due to inadequate fluid intake or excessive loss, is a common cause of shock in children. 2) Children are more susceptible to fluid loss than adults due to their higher surface area to volume ratio and metabolic rate. 3) Initial assessments of a shocked child include evaluating perfusion, signs of shock like tachycardia and cold skin, and providing rapid IV boluses of 0.9% saline or Hartmann's solution until the child is out of shock.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd

    Shock and Management

    Uploaded by

    raffepunzel
    51 views10 pages
    1) Acute hypovolemia, or a loss of fluid from the intravascular space due to inadequate fluid intake or excessive loss, is a common cause of shock in children. 2) Children are more susceptible to fluid loss than adults due to their higher surface area to volume ratio and metabolic rate. 3) Initial assessments of a shocked child include evaluating perfusion, signs of shock like tachycardia and cold skin, and providing rapid IV boluses of 0.9% saline or Hartmann's solution until the child is out of shock.

    Original Description:

    Shock and management in paediatrics

    Original Title

    3. Shock and Management

    Copyright

    © © All Rights Reserved

    Available Formats

    PPTX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    1) Acute hypovolemia, or a loss of fluid from the intravascular space due to inadequate fluid intake or excessive loss, is a common cause of shock in children. 2) Children are more susceptible to fluid loss than adults due to their higher surface area to volume ratio and metabolic rate. 3) Initial assessments of a shocked child include evaluating perfusion, signs of shock like tachycardia and cold skin, and providing rapid IV boluses of 0.9% saline or Hartmann's solution until the child is out of shock.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    51 views10 pages

    Shock and Management

    Uploaded by

    raffepunzel
    1) Acute hypovolemia, or a loss of fluid from the intravascular space due to inadequate fluid intake or excessive loss, is a common cause of shock in children. 2) Children are more susceptible to fluid loss than adults due to their higher surface area to volume ratio and metabolic rate. 3) Initial assessments of a shocked child include evaluating perfusion, signs of shock like tachycardia and cold skin, and providing rapid IV boluses of 0.9% saline or Hartmann's solution until the child is out of shock.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 10

    SHOCK

    • Acute hypovolemia is the most common


    cause of shock in children
    • A child is very susceptible to fluid loss due to
    higher surface area to volume ratio and higher
    basal metabolic rate.
    • There will be loss of fluid from
    INTRAVASCULAR SPACE secondary to
    • Inadequate intake
    • Excessive loss (vomit, diarrhoea, blood loss)
    ↓blood
    volume
    ↓ preload

    ↓ cardiac ↓ stroke
    output volume

    Thus, ↑ ↑ heart rate and


    sympathetic and cardiac
    adrenal activity contractility

    ↑ arterial and
    capillary
    constriction
    INITIAL ASSESSMENTS
     ASSESS the state of perfusion of the child
     Is the child is shock?
     Signs:
    • tachycardia
    • weak peripheral pulses
    • delayed capillary refill time > 2 seconds
    • cold peripheries
    • depressed mental state with or without hypotension

     Does the child need resuscitation A, B, C, D…


    Assessment of Dehydration

    IF IN SHOCK

    • 10-20 ml/kg of 0.9%


    Normal Saline or
    Hartmann’s solution as a
    rapid IV bolus.
    • Repeated if necessary
    until patient is out of
    shock
    • Review after each bolus and
    consider other causes of
    shock if child is not
    responsive to fluid bolus
    • Once circulation restores,
    commence rehydration,
    provide maintenance and
    replace ongoing losses
    Management

    Initial resuscitation
    • Airway should be assessed immediately upon
    arrival and stabilized if necessary. The rate of
    respirations, breath sounds, and need for
    intubation should be assessed
    • Breathing - High-flow supplemental O2 should be
    administered to all patients, and ventilatory
    support should be given, if needed.
    • Circulation - Two large-bore IV lines should be
    started and necessary blood investigations should
    be taken as a baseline
    – Weigh the patient
    – Empty stomach via nasogastric tube
    – Access severity of dehydration
    – Access level of consciousness (GCS)
    – Insert urinary catheter for the child if unconscious
    or unable to void on demand and also to monitor the
    urine output
    Fluid type andRequirement in
    Neonate and Paediatrics
     Neonates:
     D1 60mls/kg/day (D10%)
     D2 90mls/kg/day (1/5NSD10%)
     D3 120mls/kg/day
    ◼ D4- 1m 150mls/kg/day

     Infant
    ◼ 1m- 6m 150mls/kg/day ( 1/5NSD5%)
    ◼ 6m-1y 120ml/kg/day ( ½ NSD5%)
     > 1 year Holliday –Segar Formula
    Prescribing Intravenous Fluids
    Calculating Maintenance Fluid
    Requirement
    Calculating Deficit Fluid Requirement

     The rate of rehydration should be adjusted with ongoing clinical


    assessment – 4-6 hourly

     Use an isotonic solution for replacement of the deficit

     Ongoing losses > 0.5ml/kg/hr needs to be replaced with 0.9% Normal


    Saline or Hartmann’s

    You might also like