PEDIATRIC SHOCK

WRITTEN BY :
ARGIA ANJANI
110 2013 041

MENTOR :
DR. PULUNG M. SILALAHI, SP.A

KEPANITERAAN KLINIK ILMU KESEHATAN ANAK

FAKULTAS KEDOKTERAN UNIVERSITAS YARSI
RUMAH SAKIT BHAYANGKARA TK. I RADEN SAID SUKANTO
DEFINITION

Shock is a state of acute energy failure in

which there is not enough adenosine
triphosphate (ATP) production to support
systemic cellular function.
CLASSIFICATION

TYPE PRIMARY INSULT COMMON CAUSES

HYPOVOLEMIC Decreased circulating Dehydration,

blood volume hemorrhage, capillary
leaks
DISTRIBUTION Vasodilatation – venous Sepsis, anaphylactic
pooling – decreased drug intoxication,
preload spinal cord injury
OBSTRUCTIVE Obstruction of cardiac Cardiac tamponade,
filling/outflow tension pneumothorax
CARDIOGENIC Decreased contractility Congenital heart
disease, myocarditis
Hypovolemic shock
—  Result of inadequate circulating blood volume, caused
by sudden blood loss, severe dehydration, or injuries
that cause significant fluid shifts from the intravascular
space to the interstitial space (e.g., burns)
Clinical Manifestation based on
Blood Loss Percentage
DISTRIBUTIVE SHOCK
Cardiogenic shock
—  Cardiogenic shock is recognized as a low-cardiac-output
state secondary to extensive left ventricular (LV)
infarction, development of a mechanical defect (e.g.,
ventricular septal defect or  papillary muscle rupture),
or right ventricular (RV) infarction.
Obstructive shock
Obstructive shock  is a form of  shock  associated with
physical obstruction of the  great vessels  or the  heart
itself. Tension pneumothorax  and  cardiac tamponade are
considered forms of obstructive shock.
Tension Pneumothrax
Pericardial Tamponade
Stages of shock
The body activates compensatory mechanisms in
an effort to maintain circulatory volume, blood
pressure, and cardiac output.
—  Normal vital signs and cerebral perfusion, and the
shock state often goes unrecognized.
Compensatory mechanisms begin to fail, metabolic
and circulatory derangements become more
pronounced, and the inflammatory and immune
responses may become fully activated.
—  Signs of dysfunction in one or more organs may
become apparent.
In the final, irreversible stage, cellular and
tissue injury are so severe that the patient’s
life is not sustainable even if metabolic,
circulatory, and inflammatory derangements
are corrected.
—  Full-blown multisystem organ dysfunction
syndrome (MODS) may become evident.
Diagnosing shock
—  Anamnesis

—  Physical Examination

—  Laboratory Findings
Anamnesis
—  Lack of fluids intake and/or profuse fluids loss

—  Any kinds of cardiac diseases

—  Any kinds of severe illness (Sepsis, anaphylactic

reaction, injury of back bone etc.)

—  Any kinds of trauma or patalogic process on chest/lung

Physical examination
—  Decrease of mental status, & other signs of organ
hypoperfusion e.g. decreased urine output, elevated
LFTs, bilirubin

—  Hypotension

—  Tachycardia, or arrythmia, or bradycardia (depend on

the causa & stadium of shock)

—  Cold acral
Laboratory findings
—  Metabolic asidosis for all kinds of shock

—  Hemoconcentration for hypovolemic shock

—  Bacteriemia for septic shock

—  Tension (pneumothorax with lung collaps and

mediastinum shift on chest x-ray) for obstructive shock

—  Cardiomegali or abnormality of cardiac appearance in

chest x-ray and ECG for cardiac shock
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