PALS 2020 Shock QUESTIONS AND VERIFIED SOLUTIONS
Shock - ✔✔Shock is defined as a physiologic state characterized by inadequate tissue
perfusion to meet metabolic demand and tissue oxygenation. metabolic demand -
✔✔what cardiac output is normally equal to How can shock be characterized? - ✔✔By
inadequate peripheral and end organ perfusion. Also it can be characterized by low cardiac
output and decreased level of consciousness. What types of shock can cause a high
cardiac output? - ✔✔Shock thats caused by sepsis or anaphylaxis cardiac out put can be
high All types of shock can do what to organs? - ✔✔Can result in impared function of vital
organs such as the brain (Decreased level of consciousness) and kidneys ( Low urine
output and ineffective filtering) What will occur if adequate o2 delivery to the tissues is not
maintained? - ✔✔Organ dysfunction What are the major functions of the cardiopulmonary
system? - ✔✔Delivers oxygen to body tissues Removes metabolic by products of cellular
metabolism Tissue hypoxia - ✔✔This is present when a region of the body or an organ is
deprived of adequate O2 supply. What does cardiac output determine and vascular
resistance determine? - ✔✔Determines adequate blood flow to the tissues Cardiac output
- ✔✔The volume of blood pumped by the heart per minute is the product of stroke volume
and heart rate Cardia output=Stroke volume X Heart Rate Stroke volume - ✔✔The volume
of blood pumped by the ventricles with each contraction Cardia output=Stroke volume X
Heart Rate - ✔✔According to this formula if the heart rate decreases, stroke volume must
increase commensurately to maintain the cardiac output. How can cardiac output
increase? - ✔✔By an increase in heart rate, in stroke volume or both What are the limits of
increased cardia output produced by increasing heart rate? - ✔✔If the rate is too fast, as
can happen with tachyarrhythmias, stroke volume can fall bc there is inadequate time to
fill the heart. As shock develops, compensatory mechanisms attempt to? - ✔✔Attempt to
maintain O2 delivery to vital organs vasoconstriction - ✔✔the constriction of blood
vessels, which increases blood pressure. Name the compensatory mechanisms -
✔✔Tachycardia Increased systemic vascular resistance (SVR) (vasoconstriction)
Increased strength of cardiac contraction (Contractility) Increase in venous smooth
muscle tone The body's first action to maintain cardiac output is to? - ✔✔Is to increase
heart rate, or tachycardia, which can increase cardiac output to a limited degree When O2
delivery to the tissues is compromised what happens? - ✔✔Blood flow is redirected or
shunted from nonvital organs and tissues ( like skin, skeletal muscles, gut, kidneys) to vital
organs like brain, heart What is another mechanism to maintain stroke volume and cardiac
output? - ✔✔Is increased strength of cardiac contractions, or contractility, with more
complete emptying of the ventricles What else can support stroke volume? - ✔✔Can be
, supported by increased venous smooth muscle tone, improving venous return to the heart
and preload How is blood pressure determined - ✔✔product of Cardiac output and
Systemic Vascular Resistance (SVR) As cardiac output decreases blood pressure is
maintained by? - ✔✔By an increase in SVR pulse pressure - ✔✔The difference between the
systolic and diastolic blood pressure often narrows bc increased SVR raises the diastolic
pressure. systolic pressure - ✔✔Blood pressure in the arteries during contraction of the
ventricles. diastolic pressure - ✔✔occurs when the ventricles are relaxed; the lowest
pressure against the walls of an artery If cardiac output is inadequate, tissue perfusion is?
Signs of poor tissue perfusion? - ✔✔Is compromised, even if blood pressure is normal.
Lactic acidosis and end organ dysfunction will be present even if blood pressure is normal
When SVR cannot increase further blood pressure? - ✔✔Blood pressure begins to decline.
Then O2 delivery to organs is severely compromised Myocardium - ✔✔Muscular tissue of
the heart When SVR cannot increase O2 delivery to myocardium becomes? This can
cause? - ✔✔Ultimately O2 delivery to the myocardium becomes inadequate, causing
myocardial dysfunction, decreased stroke volume and hypotension Can rapidly lead to
cardiovascular collapse, cardiac arrest, and irreversible end organ injury How is shock
severity frequently characterized? - ✔✔By its effect on systolic blood pressure. Shock is
described as compensated if compensatory mechanisms can maintain a systolic blood
pressure within normal range, or above the fifth percentile systolic blood pressure for age
Clinical findings of compensated shock - ✔✔Tachycardia, delayed capillary refill, and
decreased urine output Hypotensive shock - ✔✔When compensatory mechanisms fail and
systolic bp declines shock is classified as hypotensive, previously referred to as
decompensated Shock may be present even if the childs bp is? - ✔✔Is normal How can
you identify hypotensive shock and compensated shock? - ✔✔You can easily identify
hypotensive shock by measuring blood pressure, while you may find it more difficult to
diagnose compensated shock. Use what to determine shock severity? - ✔✔Blood pressure
Compensated shock - ✔✔Shock with adequate blood pressure. May have a normal or high
systolic bp due to fight or flight response Hypotensive shock - ✔✔Shock with a low bp.
occurs when compensatory mechanisms have failed What are the typical clinical findings
with compensated shock - ✔✔Tachycardia Delayed capillary refill Decreased urine output
When will you see signs of poor tissue perfusion? - ✔✔When cardiac output is decreased
and blood pressure is normal The more time that passes between the onset of signs of
shock and the restoration of adequate O2 delivery and organ perfusion, what happens to
the child? - ✔✔The poorer the outcome. Immediate intervention for a child in shock may
be lifesaving Goals in treating shock? - ✔✔Improve O2 delivery Balance tissue perfusion
Shock - ✔✔Shock is defined as a physiologic state characterized by inadequate tissue
perfusion to meet metabolic demand and tissue oxygenation. metabolic demand -
✔✔what cardiac output is normally equal to How can shock be characterized? - ✔✔By
inadequate peripheral and end organ perfusion. Also it can be characterized by low cardiac
output and decreased level of consciousness. What types of shock can cause a high
cardiac output? - ✔✔Shock thats caused by sepsis or anaphylaxis cardiac out put can be
high All types of shock can do what to organs? - ✔✔Can result in impared function of vital
organs such as the brain (Decreased level of consciousness) and kidneys ( Low urine
output and ineffective filtering) What will occur if adequate o2 delivery to the tissues is not
maintained? - ✔✔Organ dysfunction What are the major functions of the cardiopulmonary
system? - ✔✔Delivers oxygen to body tissues Removes metabolic by products of cellular
metabolism Tissue hypoxia - ✔✔This is present when a region of the body or an organ is
deprived of adequate O2 supply. What does cardiac output determine and vascular
resistance determine? - ✔✔Determines adequate blood flow to the tissues Cardiac output
- ✔✔The volume of blood pumped by the heart per minute is the product of stroke volume
and heart rate Cardia output=Stroke volume X Heart Rate Stroke volume - ✔✔The volume
of blood pumped by the ventricles with each contraction Cardia output=Stroke volume X
Heart Rate - ✔✔According to this formula if the heart rate decreases, stroke volume must
increase commensurately to maintain the cardiac output. How can cardiac output
increase? - ✔✔By an increase in heart rate, in stroke volume or both What are the limits of
increased cardia output produced by increasing heart rate? - ✔✔If the rate is too fast, as
can happen with tachyarrhythmias, stroke volume can fall bc there is inadequate time to
fill the heart. As shock develops, compensatory mechanisms attempt to? - ✔✔Attempt to
maintain O2 delivery to vital organs vasoconstriction - ✔✔the constriction of blood
vessels, which increases blood pressure. Name the compensatory mechanisms -
✔✔Tachycardia Increased systemic vascular resistance (SVR) (vasoconstriction)
Increased strength of cardiac contraction (Contractility) Increase in venous smooth
muscle tone The body's first action to maintain cardiac output is to? - ✔✔Is to increase
heart rate, or tachycardia, which can increase cardiac output to a limited degree When O2
delivery to the tissues is compromised what happens? - ✔✔Blood flow is redirected or
shunted from nonvital organs and tissues ( like skin, skeletal muscles, gut, kidneys) to vital
organs like brain, heart What is another mechanism to maintain stroke volume and cardiac
output? - ✔✔Is increased strength of cardiac contractions, or contractility, with more
complete emptying of the ventricles What else can support stroke volume? - ✔✔Can be
, supported by increased venous smooth muscle tone, improving venous return to the heart
and preload How is blood pressure determined - ✔✔product of Cardiac output and
Systemic Vascular Resistance (SVR) As cardiac output decreases blood pressure is
maintained by? - ✔✔By an increase in SVR pulse pressure - ✔✔The difference between the
systolic and diastolic blood pressure often narrows bc increased SVR raises the diastolic
pressure. systolic pressure - ✔✔Blood pressure in the arteries during contraction of the
ventricles. diastolic pressure - ✔✔occurs when the ventricles are relaxed; the lowest
pressure against the walls of an artery If cardiac output is inadequate, tissue perfusion is?
Signs of poor tissue perfusion? - ✔✔Is compromised, even if blood pressure is normal.
Lactic acidosis and end organ dysfunction will be present even if blood pressure is normal
When SVR cannot increase further blood pressure? - ✔✔Blood pressure begins to decline.
Then O2 delivery to organs is severely compromised Myocardium - ✔✔Muscular tissue of
the heart When SVR cannot increase O2 delivery to myocardium becomes? This can
cause? - ✔✔Ultimately O2 delivery to the myocardium becomes inadequate, causing
myocardial dysfunction, decreased stroke volume and hypotension Can rapidly lead to
cardiovascular collapse, cardiac arrest, and irreversible end organ injury How is shock
severity frequently characterized? - ✔✔By its effect on systolic blood pressure. Shock is
described as compensated if compensatory mechanisms can maintain a systolic blood
pressure within normal range, or above the fifth percentile systolic blood pressure for age
Clinical findings of compensated shock - ✔✔Tachycardia, delayed capillary refill, and
decreased urine output Hypotensive shock - ✔✔When compensatory mechanisms fail and
systolic bp declines shock is classified as hypotensive, previously referred to as
decompensated Shock may be present even if the childs bp is? - ✔✔Is normal How can
you identify hypotensive shock and compensated shock? - ✔✔You can easily identify
hypotensive shock by measuring blood pressure, while you may find it more difficult to
diagnose compensated shock. Use what to determine shock severity? - ✔✔Blood pressure
Compensated shock - ✔✔Shock with adequate blood pressure. May have a normal or high
systolic bp due to fight or flight response Hypotensive shock - ✔✔Shock with a low bp.
occurs when compensatory mechanisms have failed What are the typical clinical findings
with compensated shock - ✔✔Tachycardia Delayed capillary refill Decreased urine output
When will you see signs of poor tissue perfusion? - ✔✔When cardiac output is decreased
and blood pressure is normal The more time that passes between the onset of signs of
shock and the restoration of adequate O2 delivery and organ perfusion, what happens to
the child? - ✔✔The poorer the outcome. Immediate intervention for a child in shock may
be lifesaving Goals in treating shock? - ✔✔Improve O2 delivery Balance tissue perfusion
