Shock. Sarah A. Murphy, MD Pediatric Critical Care Fellow MassGeneral Hospital for Children Boston, MA. What is shock??. Shock. State of acute energy failure, in which there is not enough ATP production to support cellular function To make ATP (body’s energy source) you need: Oxygen
Sarah A. Murphy, MD
Pediatric Critical Care Fellow
MassGeneral Hospital for Children
2. Lack of glucose delivery
3. Mitochondrial dysfunction
Stroke Volume x Heart Rate
function of (Preload, Cardiac Contractility, Afterload)
* Congenital heart disease = an important cause of shock in the neonate!
Commonly, from left-sided obstructive lesions (ex: hypoplastic left heart and coarctation of aorta)
These may present up to two weeks of age, when ductus arteriosis closes
In neonate presentating with shock, check:
* For possible cardiogenic shock with hypovolemia, give 5 to 10mL/kg, Evaluate target end points and slowly give another 5 to 10 cc/kg if there has been improvement or no change.
Adapted from: Carcillo, JA, Fields, AI. Clinical practice parameters for hemodynamic support of pediatric and neonatal patients in septic shock. Crit Care Med 2002; 30:1365.
(CO= SV x HR)
The first clinical indication of shock is: