Pediatric Shock Part 7 Distributive Shock

Anaphylactic Shock

Results from a severe reaction to medications, food, vaccines, venom, or other antigens

Symptom onset may occur within minutes or hours

Characterized by systemic vasodilation and increased capillary permeability and pulmonary vasoconstriction

Symptoms

·         Anxiety, agitation

·         Nausea, vomiting

·         Urticaria

·         Angioedema

·         Respiratory distress, stridor

·         Hypotension

·         Tachycardia

Management of Anaphylactic Shock

·         Administer supplemental oxygen

·         Fluid boluses with 20ml/kg isotonic crystalloids

·         Epinephrine

·         Albuterol for bronchospasm

·         Antihistamines

·         Corticosteroids

Neurogenic Shock

·         Disruption of the sympathetic innervation to the heart and blood vessels

·         Loss of smooth muscle control in vessel walls leads to massive vasodilation

·         Usually caused by a cervical spinal injury

·         May result from head injury of thoracic spinal injury above the T6 level

Symptoms

·         Hypotension

·         Widened pulse pressure

·         Bradycardia or normal heart rate

·         Labored respirations,

·         Diaphragmatic respirations

Note:  Because of the disruption in the sympathetic innervation to the heart, the heart rate will not increase to compensate for the loss of vascular tone.

Obstructive Shock

·         It is caused by a physical obstruction that impedes cardiac output

·         Cardiac tamponade

·         Tension pneumothorax

·         Massive pulmonary embolism

·         Congenital heart lesions

Cardiac tamponade symptoms

Muffled heart tones

Pulsus paradoxous

Distended neck veins

Tension pneumothorax symptoms

·         Hyperresonance on the affected side

·         Diminished breath sounds on the affected side

·         Distended neck veins

·         Tracheal deviation towards the unaffected side

Massive pulmonary embolism

·         Ventilation/perfusion mismatch

·         Hypoxemia

·         Increased PVR

·         Symptoms of right heart failure

Congenital heart lesions

·         Symptoms depend upon location of congenital lesion

·         Often recognized within the first 2 weeks of life

·         Pulmonary ductal lesions present with cyanosis

·         Left ventricular outflow lesions present with poor cardiac output, CHF

Note:  Left ventricular outflow lesions present within the first two weeks of life after closure of the ductus arteriosus. 


Source

Pediatric Advanced Life Support Provider Manual by Leon, M.D. Chameides, Ricardo A., M.D. Samson, Stephen M., M.D. Schexnayder and Mary Fran, RN Hazinski (Oct 12, 2011)