Diseases, Disorders information

So overall, what is going to be the therapy for your shock state? You are going to treat the underlying cause. If you are suspicious that somebody has septic shock, some antibiotics might be a good thing to do. You are going to stabilize their airway and breathing, that is, if they have quit breathing you are going to breathe for them, and you are going to administer fluids. And this is where you are going to want to pay attention to the underlying etiology of the shock. For all of the forms that we talked about, other than cardiogenic shock, fluids are going to be your mainstay of therapy and may require very large volumes of fluid. Usually given in 20 ml/kg aliquots and they may end up getting 100 ml/kg over a couple of hours. Now if you are concerned that someone is in cardiogenic shock, that is not going to help them out. You are going to make their cardiogenic shock worse. So I think that certainly if they don’t respond to an initial fluid resuscitation you are going to want to reassess all of the suggestive findings of cardiogenic shock; liver size, pulmonary findings, jugular venous distention.
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If the fluid is not being effective, regardless of the form of shock, or if you are dealing with cardiogenic shock you are going to want to move on to inotropic agents and vasoactive agents. Some of them that are utilized include epinephrine, which affects all of your receptors – alpha, beta receptors – and maybe your first drug of choice in septic shock because of it’s nice effects on the vasculature. Norepinephrine is a potent vasoconstrictor and something you may lean towards with a severe distributive shock. Dopamine has multiple effects which may be beneficial. If you are dealing with a specific cardiogenic shock, you are looking for something with good inotropic support – that is, increase the contractility of the heart. Dobutamine and milrinone are likely to be the drugs that you are going to utilize. Oftentimes combination drugs are used, either similar classes or different classes. It would not be unusual to combine milrinone and dobutamine, or milrinone and another inotropic agent, or the combination of vasoactive agents, vasoconstrictors such as epinephrine and norepinephrine plus a little dopamine to hopefully help renal perfusion.
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Remember one member of distributive shock, that is spinal cord injury, should get high doses of steroids given early as it has been shown to improve long term spinal cord function.
Trauma is the leading cause of death in children more than one year of age. Under a year of age it’s kind of a whole hodgepodge of congenital difficulties. Once you get to a year of age, if you’ve made it that far, you are most likely to die of trauma than anything else. The key to trauma is to prevent it. Anticipatory guidance, seat-belts, don’t have open windows on third stories where children are likely to plummet to their death.