C is for Circulation (part 1 of 2)12 August, 2010 by: colinparker
Shock, dehydration, fluid management… How do we assess and manage the circulation in a paediatric emergency?
Learn about the clinical assessment of the Circulation in this PEMcast.
Click on the play button below to listen to this podcast, or subscribe using the iTunes button on the left…
Overview of Circulation (part 1) PEMcast
(CP) Introduction, disclaimer & welcome (gastro to be explored in separate episode)
(KB) Elements: HR, CFT, pulses, BP, skin perfusion, mental status, urine output, general appearance (etc)
(SF) Shock: signs
(MB) Decreased BP late sign (why?)
(CP) ‘warm shock’ rare in kids
(KB) CFT caveats
(SF) Cutis marmorata can be normal or abnormal
(CP) Shock: causes (CHOD = cardiogenic, hypovolaemic, obstructive, distributive)
(KB) Shock: treatment: seek & treat cause; N/Saline boluses 20mL/kg; inotropes after 3rd bolus?
(SF) What inotrope? Adrenaline usually, Noradrenaline good for vasodilation in sepsis?
Dehydration – clinical signs & their evidence base:
See Steiner 2004 and Gorelick scale 1997
(CP) Fluid compartments & shifts (radio-labelled albumin experiments)
(KB) Various ‘scales’, unvalidated, no good evidence base
(MB) Local (PMH) study – inter-observer correlation
(SF) Steiner 2004: More features = more likely to be dry
Most predictive = CFT, respiratory pattern, skin turgor
Normal urine output reassuring, decreased urine output (by parental report) not predictive of dehydration
(All) Can we predict % dehydration clinically?
(KB) WHO recommendations now = none/some/severe