Wednesday Lectures, 8/12/2015: Shock Day

TTHM a2.3 Shock Day   Tintinalli 25, 26, 28, 29, 30, 31, 32, 33, 34, 54, 146.


12p ~ Board Review (Cantor)

Congenital heart lesions, Clonidine Toxicity, bilious kid <3mo ~ malro/volvulus, constipation with empty rectal vault consider Hirschsprung, clostridium botulinum, laryngomalacia in kids, HF tox treat c Ca gluconate, HUS c ecoli bad beef, sickle cell splenic crisis, organophosphate poisoning with pralidoxime & atropine, ketamine preserves respiratory drive, packers v stuffers, ketamine at NMDA/glutamate antagonist like PCP,


130p ~ Acute Airway Management (Sarsfield)

Look externally, Evaluate 3-3-2, Mallampati, Obstruction/Obesity, Neck Mobility

Can we Ventilate? Can we Tube?  Always have BVM & Suction as backup!

Facial deformity may necessitate cric…


215p ~ RSI (Joslin)

Plan/Prepare/Protect Cspine (LEMON, Ccollar?, glidescope, bougie, shiley…)

Position, Preoxygenate, (SOAPME ~ Suction, O2, Airways, Pos, Mon/Meds, EtCO2/equipmt)

Pretreat meds to Induce (Etom, Ket, Propofol, Versed, consider Fentanyl, Atropine, Lidocaine),

Paralysis (Sux v Vec/Roc),

Placement & Proof (Direct Visualization, EtCO2, CXR)

PostIntubation Mgmt (Secure tube, Vent settings, Gtube, CXR, Resp Therapy, MICU)


245p ~ Hypovolemic Shock (Thurber) v Distributive, Cardiogenic, Obstructive…

Hemorrhagic & Nonhemorrhagic

Hemorrhagic includes Traumatic & NonTraumatic (GI, Coag, OB…)

NonHemorrhagic includes 3rd spacing & extracorporeal volume loss (dehydration)


3p ~ Early Shock in Peds (Cantor)

Babies shunt well so cap refill is important assessment measure.

Vasoactive & inflammatory factors, lactate… Tachycardia does happen in kids.

Recognize SIRS/Sepsis early & get IVF/Abx early!!! Get BldCxs, but don’t wait for LP!!!

Consider pressors & intubation early.

Holes & Blocks (LVO, AoSten, hypoplLV, Coarct, …>2wks) (ASD, VSD, canal, PDA, <10days)

5 Ts: TGA, TricAtr, TetFallot, TtPVR, Truncus (HippoEM)



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