Pediatric Shock Part 2 General Management
General Management of Shock
· Positioning
· Airway and breathing
· Vascular access
· Fluid resuscitation
· Monitoring
· Frequent reassessment
· Diagnostic studies
· Pharmacological therapy
· Expert consultation
Positioning
· Stable- allow to remain with caregiver in a position of comfort
· Unstable- Trendelenburg if hypotensive
Airway and Breathing
· High concentration oxygen via NRB mask
· Consider transfusion if low blood count
· Consider ventilator, CPAP, or noninvasive positive airway pressure
Vascular Access
· Peripheral IV if possible
· Consider IO access
· Consider central line
· Consider central line
Fluid Resuscitation
· Isotonic crystalloids 20ml/kg over 5-20 minutes
· Repeat boluses as needed
· Colloids or PRBCs if needed
· Decrease volume and rate with myocardial dysfunction
Monitor
· SpO2
· Heart rate
· Blood pressure
· Level of Consciousness
· Temperature
· Urine output
· SVO2
Frequent Reassessment
· Evaluate response to interventions
· Reevaluate hemodynamic trends
Conduct Diagnostic Studies
· Identify etiology of shock
· Evaluate end organ dysfunction
· Identify metabolic abnormalities
· Evaluate response to interventions
Pharmacological therapy
· Improve cardiac output
· Reduce or increase SVR
· Improve end organ perfusion
· Correct metabolic abnormalities
· Manage pain and anxiety
Expert consultation
• Recognize limitation
• Enlist help of other subspecialties
Source
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