Pediatric Shock

Jolie, BSN · May 10, 2004

I am lecturing on Pediatric Shock. I have had some (but not a lot) pediatric nursing experience. Any suggestions on writing this lecture would be MOST appreciated.

My only experience has been with newborns with beta strep sepsis who have gone into septic shock. It is frightening how rapidly they deteriorate before your very eyes.

Try any of Mary Fran Hazinski's text books for a starting point. She is one of the best authors in Pediatric Critical Care.

VickyRN, MSN, DNP, RN · May 10, 2004

My only experience has been with newborns with beta strep sepsis who have gone into septic shock. It is frightening how rapidly they deteriorate before your very eyes.
Try any of Mary Fran Hazinski's text books for a starting point. She is one of the best authors in Pediatric Critical Care.

Thanks for the tip! I will certainly check out this author's works :)

Gompers, BSN, RN · May 10, 2004

Could you be more specific as to what kind of information you're interested in? Like maybe post a bunch of questions for us? Will be glad to help, but it's kind of a broad topic as a whole.

VickyRN, MSN, DNP, RN · May 10, 2004

Could you be more specific as to what kind of information you're interested in? Like maybe post a bunch of questions for us? Will be glad to help, but it's kind of a broad topic as a whole.

You're right! It's a terribly broad topic! And I don't know enough right now to even ask questions. I'm going to work on my lecture, then I will return with PLENTY of questions :chuckle I want to sincerely thank the members of this BB for all their help to me in my growing pains as a new nursing instructor.

Gompers, BSN, RN · May 11, 2004

You're right! It's a terribly broad topic! And I don't know enough right now to even ask questions. I'm going to work on my lecture, then I will return with PLENTY of questions :chuckle I want to sincerely thank the members of this BB for all their help to me in my growing pains as a new nursing instructor.

Sure, come back when you have some more specific questions. I'd be glad to help when you do! I work NICU but I don't know that they treat older kids any different than we do the babies in these situations. (Mostly our shock is septic, but sometimes it's hypovolemic.) Shock is one of the most fascinating topics to me. It's just so challenging!

RNCENCCRNNREMTP · May 11, 2004

I am lecturing on Pediatric Shock. I have had some (but not a lot) pediatric nursing experience. Any suggestions on writing this lecture would be MOST appreciated.

A few blurbs...

Hypovolemic shock is most common shock type in kids

Tachycardia and increased vascular resistance are important early signs, don't miss them.

Hypotension is a LATE sign (after 40% volume lost) don't wait for it.

Prolonged cap refill is only reliable in a warm environment.

Kids with profound dehydration may need 60-100cc/kg IV fluids over the first few hours.

If cardiac arrest occurs there is less than 10% survival rate, prevent it (compared to 75% survive if only resp arrest).

Recovery from arrest is rare (see above) and is often complicated by a cardiogenic shock from depleted O2 and glucose stores. Kids will need epi drips sooner than adults.

A few thoughts off the top of my head this am.

VickyRN, MSN, DNP, RN · May 12, 2004

Thank you very much. This is great. We are harping on the topic over and over again this summer that children are NOT just miniature adults. And with children, cardiac arrest is always the result of respiratory arrest. Once they decompensate to the point of cardiac arrest, it is very difficult to bring them back.

Gompers, BSN, RN · May 12, 2004

A few blurbs...
Hypovolemic shock is most common shock type in kids
Tachycardia and increased vascular resistance are important early signs, don't miss them.
Hypotension is a LATE sign (after 40% volume lost) don't wait for it.
Prolonged cap refill is only reliable in a warm environment.
Kids with profound dehydration may need 60-100cc/kg IV fluids over the first few hours.
If cardiac arrest occurs there is less than 10% survival rate, prevent it (compared to 75% survive if only resp arrest).
Recovery from arrest is rare (see above) and is often complicated by a cardiogenic shock from depleted O2 and glucose stores. Kids will need epi drips sooner than adults.
A few thoughts off the top of my head this am.

I was recently at a pediatric trauma lecture, they stressed exactly the points you made. It's scary how stable these kids can be and then BOOM they're crashing.

Like I said, in the NICU it's mostly septic shock, but since these kids third space, hypovolemia definitely comes into play before long.

We treat with increased fluids, saline boluses, blood transfusions, dopamine and dobutamine, antibiotics, sodium bicarb, albumin, and high dose IV hydrocortisone. Once in a blue moon we'll have a baby on an epi drip, but 95% of the time it's been started down in the OR during a bloody surgery gone awry.

What do you do in PICU or ER that's different? I'm so curious!

RNCENCCRNNREMTP · May 12, 2004

And with children, cardiac arrest is always the result of respiratory arrest. .

Not ALWAYS but certainly most common. One study showed progression to cardiac arrest secondary to: respiratory cause 80%, shock 10% and primary cardiac abnormality 10% (Internal Data. B.C. Children's Hospital, Vancouver. 1989.)

PA-C in Texas · May 13, 2004

I don't know which kind of crowd you are preaching to, so my suggestion might be totally inappropriate as it is too basic.

The Pediatric Advanced Life Support provider manual may be a good starting place. It is pretty extensively researched and they provide sources in many instances.

One thing that I would just add (even though I am certainly not an EXPERT in pediatrics), is that it is important to expound on the differences in cardiac dysrhythmias/arrhythmias in adults and children. For example, rates as high as two-hundred may be due to enhanced automaticity from the compensatory mechanism rather than a re-entry phenomenon that would be cause for treatment with adenosine or synchronized cardioversion. The most common malignant rhythms you will be treating are bradydysrhythmias (usually not atrioventricular blocks), and asystole. As has already been said, kids are not little adults.

I also agree 100% with RNCENCCRNNREMTP. Everyone knows the 10 cc/kg for neonates and 20 cc/kg for everyone else, but that is intended as an initial bolus after which time you would re-assess. If it is working, give another fluid bolus- you don't have to stop at 20.

You might also want to try the PALS instructor manual.