小儿休克的初始评估.pptxVIP

小儿 休克的初始评估Initial evaluation of shock in childrenDEFINITION a dynamic and unstable pathophysiologic state characterized by inadequate tissue perfusion. as the result -- decreased intravascular volume, abnormal distribution of intravascular volume, and/or impaired cardiovascular function. Aggressive treatment within the first few hours after presentation may prevent the invariable progression and poor outcome . EPIDEMIOLOGY1\Hypovolemia from diarrheal disease or traumatic hemorrhage and sepsis:Hypovolemia from gastroenteritis is the most common cause of pediatric shock worldwide . Widespread use of oral rehydration therapy has substantially reduced mortality 2\Trauma, including hemorrhagic shock, also remains a significant cause of death in children3\ severe sepsis occurs frequently in children around the world, especially low birth weight newborns and infants younger than one month of age, immunosuppressed patients, and children with chronic debilitating disease.4\Cardiogenic and obstructive shock occur much less frequently in children. However, clinicians must consider these etiologies since they are typically not fluid responsive and require specific therapies .Common causes of cardiogenic shock in children include Sepsis Congenital heart disease and heart failure Myocarditis Cardiomyopathy Poisoning or drug toxicity Brady- or tachyarrhythmias Thoracic trauma with blunt cardiac injury Obstructive shock can be caused by cardiac tamponade, tension pneumothorax, ductal dependent congenital cardiac lesions, or massive pulmonary embolism PATHOPHYSIOLOGY●Insufficient circulating blood volume (preload)●Changes in vascular resistance (afterload)●Heart failure (contractility)●Obstruction to blood flowDeleterious effects of decreased tissue perfusion include 1\Poor perfusion of vital organs results in impaired function.2\Lactic acid accumulates as cells switch to anaerobic metabolism to generate energy. Increased lactic acid in tissues causes metabolic acidosis, which