shock, multiple organ dysfunction syndrome, and burns in children chapter 47 mosby items and derived...

Shock, Multiple Organ Dysfunction Shock, Multiple Organ Dysfunction Syndrome, and Burns in Children Syndrome, and Burns in Children

Chapter 47Chapter 47

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.

22Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.

Shock and Multiple Organ Shock and Multiple Organ Dysfunction Syndrome (MODS)Dysfunction Syndrome (MODS)

ShockShock Commonly results from hemorrhage, severe Commonly results from hemorrhage, severe

dehydration, progressive heart failure, or sepsisdehydration, progressive heart failure, or sepsis Compensated shockCompensated shock Decompensated shockDecompensated shock


ShockShock Hypovolemic shockHypovolemic shock

Distributive or vasogenic shockDistributive or vasogenic shock Neurogenic shockNeurogenic shock

Cardiogenic shockCardiogenic shock Septic shockSeptic shock


ShockShock Dehydration, hypovolemia, low cardiac output Dehydration, hypovolemia, low cardiac output

stimulate adrenergic and renal compensationstimulate adrenergic and renal compensation Tachycardia Tachycardia Redistribution of blood from the skin, gut, and kidney to Redistribution of blood from the skin, gut, and kidney to

the brain and heart the brain and heart Reduced renal perfusion stimulates the renin-Reduced renal perfusion stimulates the renin-

angiotensin-aldosterone system, resulting in renal angiotensin-aldosterone system, resulting in renal sodium and water retention sodium and water retention

Neonatal and young infant kidneys are incapable Neonatal and young infant kidneys are incapable of excreting concentrated urineof excreting concentrated urine Compensatory mechanisms are relatively ineffective Compensatory mechanisms are relatively ineffective

during the first weeks of lifeduring the first weeks of life


Reperfusion InjuryReperfusion Injury Cellular damage caused by the restoration Cellular damage caused by the restoration

and reperfusion of oxygen to cells that have and reperfusion of oxygen to cells that have been exposed to reversible hypoxic been exposed to reversible hypoxic conditionsconditions

Occurs from the generation of highly reactive Occurs from the generation of highly reactive oxygen intermediates oxygen intermediates The amount of free oxygen radical production The amount of free oxygen radical production

depends on the severity and duration of the depends on the severity and duration of the ischemic period ischemic period


Evaluation of ShockEvaluation of Shock Arterial blood gas (ABG)Arterial blood gas (ABG) Serum lactate concentrationSerum lactate concentration Blood pressureBlood pressure Ventilation and oxygenationVentilation and oxygenation Chemistry analytesChemistry analytes

Electrolytes, glucose, BUN, liver function, calcium, Electrolytes, glucose, BUN, liver function, calcium, phosphorus, cardiac enzymesphosphorus, cardiac enzymes

Hemoglobin and hematocrit Hemoglobin and hematocrit


Treatment of ShockTreatment of Shock Adequate oxygen deliveryAdequate oxygen delivery Monitor body temperatureMonitor body temperature Transfusion of blood componentsTransfusion of blood components IV fluids (volume resuscitation)IV fluids (volume resuscitation) Monitor urine output and specific gravityMonitor urine output and specific gravity Monitor blood pressureMonitor blood pressure


Emerging Therapies for Emerging Therapies for Shock and SepsisShock and Sepsis

Injury preventionInjury prevention Haemophilus influenzaeHaemophilus influenzae and and Neisseria Neisseria

meningitidismeningitidis vaccines vaccines Colony-stimulating factors to increase white Colony-stimulating factors to increase white

blood counts in immunocompromised blood counts in immunocompromised individualsindividuals

Infectious disease controlInfectious disease control Resuscitation techniquesResuscitation techniques


Emerging Therapies for Emerging Therapies for Shock and SepsisShock and Sepsis

Mediator-specific therapiesMediator-specific therapies Continuous plasma filtrationContinuous plasma filtration Glucocorticoid administrationGlucocorticoid administration Activation of Toll-like receptorsActivation of Toll-like receptors Genetic profilingGenetic profiling


Multiple Organ Dysfunction Multiple Organ Dysfunction Syndrome (MODS)Syndrome (MODS)

Failure of at least two organs that results from a Failure of at least two organs that results from a single causesingle cause

Risk factors: sepsis, trauma, cardiopulmonary Risk factors: sepsis, trauma, cardiopulmonary arrest, congenital heart disease, liver/bone marrow arrest, congenital heart disease, liver/bone marrow transplantationtransplantation

Children with chronic diseases have an increased Children with chronic diseases have an increased risk and increased mortality risk and increased mortality


BurnsBurns A common result of inadequate supervision, A common result of inadequate supervision,

curiosity, inability to escape the burning curiosity, inability to escape the burning agent, or intentional abuseagent, or intentional abuse

Child abuseChild abuse 6% to 20% of child burn injuries are child abuse6% to 20% of child burn injuries are child abuse Pattern burns, forced emersion burns, splash/spill Pattern burns, forced emersion burns, splash/spill

burns, cigarette burnsburns, cigarette burns


BurnsBurns Scald injuriesScald injuries Contact burnsContact burns Flame burnsFlame burns Electrical burnsElectrical burns Chemical burnsChemical burns


Severity of InjurySeverity of Injury Total body surface area (TBSA)Total body surface area (TBSA) Rule of nines inaccurate in childrenRule of nines inaccurate in children

Arms and trunk demonstrate same proportions as an Arms and trunk demonstrate same proportions as an adult adult

Head and neck—18%Head and neck—18% Each lower extremity—14%Each lower extremity—14%

Depth of injuryDepth of injury Infant skin is extremely fragile and more likely to Infant skin is extremely fragile and more likely to

sustain a deeper burn sustain a deeper burn


Severity of InjurySeverity of Injury AgeAge

Younger than 2 years, a significantly higher risk for Younger than 2 years, a significantly higher risk for associated morbidity and mortality associated morbidity and mortality

Have not achieved maturity of immune system and Have not achieved maturity of immune system and are at increased risk for infection and sepsisare at increased risk for infection and sepsis

Very young children are intolerant of rapid fluid shifts; Very young children are intolerant of rapid fluid shifts; immature renal function negatively affects ability to immature renal function negatively affects ability to retain sodium and water retain sodium and water

Areas of the body burnedAreas of the body burned Secondary injuries and manifestationsSecondary injuries and manifestations


Burn Injury in ChildrenBurn Injury in Children Integumentary systemIntegumentary system Cardiovascular systemCardiovascular system Renal systemRenal system Gastrointestinal systemGastrointestinal system MetabolismMetabolism


Burn Injury in ChildrenBurn Injury in Children Immune functionImmune function Scar maturationScar maturation Burn shockBurn shock Pulmonary systemPulmonary system InfectionInfection


Burn Injury in ChildrenBurn Injury in Children Functional limitationsFunctional limitations Fluid resuscitationFluid resuscitation Wound managementWound management Pulmonary supportPulmonary support Nutritional supportNutritional support


Burn Injury in ChildrenBurn Injury in Children Comfort managementComfort management Community reintegrationCommunity reintegration

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