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Acute P aediatric Emergencies 3

Acute P aediatric Emergencies 3. Septic Shock Dr Julia Thomson General paediatric consultant with an interest in Emergency Paediatrics. Learning objectives. Shock Causes Pathophysiology Assessment of Resuscitation and emergency treatment of the child in SEPTIC shock.

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Acute P aediatric Emergencies 3

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  1. Acute Paediatric Emergencies 3 Septic Shock Dr Julia Thomson General paediatric consultant with an interest in Emergency Paediatrics

  2. Learning objectives • Shock • Causes • Pathophysiology • Assessment of • Resuscitation and emergency treatment of the child in SEPTIC shock

  3. Background: causes of shock “inadequate tissue perfusion resulting in impaired cellular respiration (ie shock) may result from defects of the pump (cardiogenic), loss of fluid (hypovolaemic), abnormalities of the vessels (distributive), flow restriction (obstructive), or inadequate oxygen-releasing capacity of blood (dissociative).”

  4. Background: pathophysiology of shock circulatory function delivery of O2 and removal of tissue nutrients to tissues waste products body’s response to cellular metabolic deficiency = shock COMPENSATED DECOMPENSATED IRREVERSIBLE

  5. Assessment of the child in shock • Assess and if necessary support • A,B,C,D,E,F,G • AIRWAY • BREATHING • Effort, (Exceptions), Efficacy, Effects • CIRCULATION • DISABILITY • EXPOSURE • (F) • GLUCOSE

  6. RESUSCITATION OF THE CHILD IN SEPTIC SHOCK • O2 • 20mls/kg normal saline • More boluses – 4.5% albumin preferred in sepsis • After 40mls/kg inotropes likely and intubation • 3rd generation cephalosporin, 80mg/kg • May need adrenaline infusion • Check Ca, Mg, glucose, blood gas and clotting • Involve CATS • ?raised ICP • Intubate, keep CO2 4-5kPa • Nurse child head up • Mannitol

  7. Questions

  8. Summary • Causes and pathophysiology of shock • Cardiogenic • Hypovolaemic • Distributive • Obstructive • Dissociative • Management of a child in septic shock • O2 • Fluids, fluids, fluids (inotropes, intubation) • Antibiotics

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