I also gave my son's daycare a print out of this... hopefully they will
never have to use it.

http://www.med.monash.edu.au/paediatrics/resources/shock.html

Shock & Sepsis

Definition:

Shock is a state of circulatory dysfunction in which tissue O2
delivery is less than required. If untreated, multi-organ failure and
death result. Shock is the final common pathway of numerous disease
states.


Aetiology:

Can be broadly classified into the following categories:

Hypovolaemic
Cardiogenic
Septic
Endocrine
Anaphylactic

Clinical signs:

Clinical signs are for the most part non-specific, and include
tachycardia, hypotension - particularly
decreased diastolic BP, gallop rhythm, oliguria, and altered
consciuosness. Additional signs of specific
underlying disorder should be sought.


Management:

Management is generally supportive. Specific treatment for the
underlying disorder is unlikely to beeffective in the short term with the
exception of adrenaline in anaphylaxis or hydrocortisone in

Addisonian crisis. As specific therapy will lead to dramatic
improvement in these patients, it is critical
to consider both conditions early in the resuscitation and treat
appropriately.



Addisonian crisis

Addisonian crisis should be suspected in patients with known
glucocorticoid deficiencies on
replacement therapy may also present if steroid doses are not
increased appropriately during
intercurrent infections or other stressful events.
Hydrocortisone doses are 50 mg IV for infants -toddlers, and
100 - 150 mg IV for older children - adults.


Management for all Shocked Patients

Otherwise, management is similar for all shocked patients:

Establish parenteral access, preferably with 2 IV lines.
If IV access cannot be established, an
intra-osseous cannula should be placed.
Provide supplemental O2
.
If cardiogenic shock (eg myocarditis, ventricular
arrhythmias etc) is excluded, give colloid in 10
ml/kg boluses until BP and HR return to acceptable levels.
Cardiogenic shock - suggested by
cardiomegally, peripheral and pulmonary oedema, low voltages
on ECG, AV valvar regurgitation
murmers - should be treated primarily with inotropes, with
volume resuscitation used cautiously if at all.

Further supportive treatment may include intubation and inotropic
support :

Intubation should be considered for any patient with depressed
consciousness (GCS <= 8) secondary to shock.
Inotropic support should be considered for any patient
unresponsive to colloid challenge of 40 -50 ml/kg in total. Inotrope
selection will depend to some extent on aetiology, but dopamine at a
starting dose of 5 - 10 ug/kg/min is a reasonable first choice in
most situations (15 mg/kg in 50ml D5 or NS at 1 - 2 ml/hour).

Antibiotics should be given in all cases of suspected septic shock,
however fundamentals such
as airway control and circulatory support must be addressed as a
higher priority. Ceftriaxone 100mg/kg IV or IM provides good broad
spectrum coverage in most situations.



Roberta Preston
HQ USAF/ILEB
1260 Air Force Pentagon
Washington, DC 20330-1260
Phone: 703 695-4512, DSN 225-4512
Fax: 703 697-5143, DSN 227-5143

----- Original Message -----
From: <CAHsupport@egroups.com>
To: <CAHsupport@egroups.com>
Sent: Tuesday, September 19, 2000 3:09 AM
Subject: [CAHsupport] Digest Number 57


>
> There is 1 message in this issue.
>
> Topics in this digest:
>
> 1. Fw: CAH Booklet Australia
> From: "preston" <preston@...>
>
>
> ________________________________________________________________________
> ________________________________________________________________________
>
> Message: 1
> Date: Mon, 18 Sep 2000 21:54:27 -0400
> From: "preston" <preston@...>
> Subject: Fw: CAH Booklet Australia
>
> Here is a web site from Australia with a book to download and print about
> CAH.
>
> Roberta
> ----- Original Message -----
> From: "Angela Strong" <jaade1@...>
> To: "preston" <preston@...>
> Sent: Sunday, July 16, 2000 1:02 PM
> Subject: Re: CAH Booklet Australia
>
>
> > I actually have this book! It is wonderful!! I found it to be
especially
> > useful when grandparents and aunts and uncles were asking questions. I
> > would highly recommend it to anyone. Thanks for forwarding the
> information
> > for it!
> >
> > Angi
> >
> >
> > ----- Original Message -----
> > From: "preston" <preston@...>
> > To: "CAHsupport Moderator" <CAHsupport-owner@egroups.com>
> > Sent: Sunday, July 16, 2000 11:10 AM
> > Subject: Fw: CAH Booklet Australia
> >
> >
> > > > The CAH Booklet " Your Child with Congenital Adrenal Hyperplasia"
> > > > written by Assoc Professor Garry Warne from the Dept of
Endocrinology
> > > > at the Royal Children's Hospital Melbourne Australia is now
available
> > > > on the Net
> > > > address is: www.rch.unimelb.edu.au/publications/
> > > >
> > > > Kind Regards
> > > > Dot Gronn
> > > >
> > >
> > >
> > >
> >
> >
>
>
>
> ________________________________________________________________________
> ________________________________________________________________________
>
>
>