Pediatric CCRN Updated 2024/2025 Verified 100%

Septic Shock Management Step Three - -Antibiotics (first 60 min) -Broad Spectrum antibiotics -Try to obtain culture first -Consider IM administration if hard to get IV access - Start with Gram Negative spectrum before Gram Positive Septic Shock Management Step One - - Recognition and Access: Diminished LOC, begin HFNC, if hypoxic intubate - Start IV access: peripheral or central What does SIRS stand for? - Systemic Inflammatory Response Syndrome Key characteristics of Endotheliopathy - • Capillary leak • Vasomotor paralysis tone of vessels not normal • Leukocyte infiltrations • Coagulopathy • Myocardial depression • Immune-compromise Patient Qualifications of SIRS based off clinical findings. - Two Abnormalities -Must be abnormalities of temperature (greater than 38 rectal or less than 36 rectal) or WBC in children -Other abnormalities include: 1. HR (Tachycardia) 2. RR (Tachypnea) 3. PaCo2 Less than 32 4. Abnormal WBC>12,000 or less than 4,0005. WBC bands greater than 10% differential Management of SIRS - 1. Treat underlying Cause 2.Manage coagulopathies: thrombocytopenia← replace platelet, clot formation← give thrombolytic, bleeding 3. Mange the endothelipathies: stop inciting insult, fluid resuscitate, increase plasma oncotic pressure (colloid administration) 4. Promote Vasoconstriction: Alpha Agonist Septic Shock - - Sepsis plus CV dysfunction: Abnormal perfusion as well as hypotension. - Children able to maintain BP longer than Adults Septic Shock Management Step Two - - Fluid Resuscitation - Rapid administration 20mL/Kg bolus of isotonic crystalloid -Run over 5-10 minutes • 0.9% NaCL (normal saline) • Lactated ringers Septic Shock Management Step Four - 4. Inotropic Agent support WARM SHOCK - 1. High cardiac output 2. Low Systemic Vascular Resistance (SVR) Inotropic Agent for Warm Shock? - 1. Dopamine 2. Nor-epi *Utilize EPI or Vasopressin if not responsiveCOLD SHOCK (normal or Low BP) - 1. Low Cardiac Output 2. High Systemic Vascular Resistance (Normal or Low BP) Inotropic Agent for Cold Shock (normal or Low BP) ? - 1. Dopamine 2. Epi *Utilize Nor-epi or Dopamine if not responsive COLD SHOCK (Low BP) - 1. Low Cardiac Output 2. Low Systemic Vascular Resistance Inotropic Agent for Cold Shock (Low BP) - 1. Dopamine 2. EPI * Utilize Milronone or Dobutamine if not responsive Catecholamine Resistant Shock - - Septic Shock when patients don't respond to inotropes - Severe Septic Shock with Purpura - Have adrenal insufficiency or have been previusly treated with high dose steriods Types of Shock? - 1. Cardiogenic: Pump Failure 2. Distributive (anaphylaxis): Issue with vasculature of vessels. Dilated vessel bad! (Tubing issue) 3. Hypovolemic: Fluid Loss 4. Septic: Failure of pump, vessels loose tone, and fluid loss What is Hypovolemic Shock? - •Decreased intravascular volume→Decrease preload→ decrease CO Causes of Hypovolemic Shock - 1. External fluid loss 2. Internal fluid loss3. Greater than Year: Hemorrhage from trauma 4. Less than a Year: Gastroenteritis or D/V 5. Other Causes: Hyperthermia- heat stroke, burn, nephrotic syndrome, DI Dehydration manifestions (depends on severity) - 1. Mental Status: Irritability, change in LOC (moderate-severe) 2. HR: Tachycardia 3. RR: Normal-Rapid 4. BP: (hypotension late sign) 5. Mucous Membrane: Dry (moderate-severe) 6. Fontanel/eyes: Sunken (moderate-severe) 7. Tears: absent (moderate-severe) 8. Pulses: Palpable decreased peripherally (moderate) Weak to absent in severe 9. Urine output: decrease amount (moderate) Oliguria to anuria in severe 10. Weight loss: ALOT Causes of Distributive Shock - •Anaphylaxis •Neurologic injury (above t1 and brainstem) •Loss of sympathetic vascular tone •Hyperthermia •Infection- component of sepsis •Adrenal Insufficiency •Pancreatitis •SIRS Anaphylactic shock - - Histamine release→ vasodilation