Resuscitation, Pediatric

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Basics

Description

  • Respiratory failure, shock, and cardiopulmonary arrest in children require timely intervention
  • Shock: A physiologic mismatch of metabolic supply and demand leading to tissue hypoxia and multisystem organ failure
  • Early recognition and treatment of respiratory insufficiency and shock can prevent progression to cardiopulmonary arrest

Etiology

  • Respiratory failure leading to pulseless electrical activity (PEA) and then asystole is the most common cause of cardiopulmonary arrest in children, although cardiac and traumatic causes are not uncommon
  • Asystole is the presenting rhythm in 2/3 of pediatric cardiopulmonary arrest; ventricular fibrillation and tachycardia are rare, occurring mostly in adolescents and children with congenital heart disease
  • Shock can be subcategorized into 4 overlapping types:
    • Hypovolemic: Inadequate circulating volume (e.g., hemorrhage or abnormal intake/output)
    • Distributive: Decreased systemic vascular resistance leading to inappropriate peripheral blood distribution (e.g., sepsis)
    • Cardiogenic: Impairment of myocardial function (e.g., myocarditis)
    • Obstructive: Obstructed cardiac filling and output (e.g., pulmonary embolism)
  • Children in septic shock may present with “warm shock” (high cardiac output, low systemic vascular resistance) or “cold shock” (low cardiac output, high systemic vascular resistance)
  • Compensated shock occurs when normal blood pressure is maintained through increased heart rate, vascular resistance, inotropy, and venous tone. This may progress to late, uncompensated shock if intervention is not timely and aggressive
  • Hypotensive shock may rapidly progress to cardiopulmonary failure/arrest

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Basics

Description

  • Respiratory failure, shock, and cardiopulmonary arrest in children require timely intervention
  • Shock: A physiologic mismatch of metabolic supply and demand leading to tissue hypoxia and multisystem organ failure
  • Early recognition and treatment of respiratory insufficiency and shock can prevent progression to cardiopulmonary arrest

Etiology

  • Respiratory failure leading to pulseless electrical activity (PEA) and then asystole is the most common cause of cardiopulmonary arrest in children, although cardiac and traumatic causes are not uncommon
  • Asystole is the presenting rhythm in 2/3 of pediatric cardiopulmonary arrest; ventricular fibrillation and tachycardia are rare, occurring mostly in adolescents and children with congenital heart disease
  • Shock can be subcategorized into 4 overlapping types:
    • Hypovolemic: Inadequate circulating volume (e.g., hemorrhage or abnormal intake/output)
    • Distributive: Decreased systemic vascular resistance leading to inappropriate peripheral blood distribution (e.g., sepsis)
    • Cardiogenic: Impairment of myocardial function (e.g., myocarditis)
    • Obstructive: Obstructed cardiac filling and output (e.g., pulmonary embolism)
  • Children in septic shock may present with “warm shock” (high cardiac output, low systemic vascular resistance) or “cold shock” (low cardiac output, high systemic vascular resistance)
  • Compensated shock occurs when normal blood pressure is maintained through increased heart rate, vascular resistance, inotropy, and venous tone. This may progress to late, uncompensated shock if intervention is not timely and aggressive
  • Hypotensive shock may rapidly progress to cardiopulmonary failure/arrest

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