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)