Children shock

Shock is common in pediatric critical severe, according to the cause can be divided into different reasons: septic shock, anaphylactic shock, cardiogenic shock, hemorrhagic shock, neurogenic shock, and its effective cycle output reduction, Is a common pathophysiological basis. Reduce blood volume, cardiac output and reduce the microcirculation, the shock is the key to the development.

Cause

① septic shock is a serious infection on the basis of the results of interaction between a variety of factors, both humoral factors and the role of cell damage, but also the changes in microcirculation, together form the complicated process of the pathophysiology.

② hemorrhagic shock due to blood loss and more, the loss of so sharp decrease in blood volume.

③ cardiogenic shock due to heart Bengxue dysfunction, cardiac output caused a sharp decrease.

④ anaphylactic shock outsiders antigen enters the body of material generated by the strong reaction of the body, leading to expansion of blood vessels, increased permeability, plasma leakage, the result of sharp decline in blood circulation.

⑤ neurogenic shock occurred in severe pain caused vascular expansion, microcirculation congestion, effective when the sharp decline in circulating blood volume, due to trauma Most of it is also called traumatic shock.

Diagnosis

Primarily on the basis of clinical manifestations, various types of shock is a common feature: looking pale and limbs Jueleng, shortness of breath, Xiruo pulse, blood pressure dropped, urine output reduction, the spirit of Weimi or irritability, and so on.

Infection in infants and young children on the basis of a fever or body temperature or not, looking pale and limbs Jueleng, anorexia, lethargy or irritability, staring eyes, irregular breathing, heart rate> 160 / points, consideration should be given shock.

Older children, after repeated chills high fever, or rectal means (toe) temperature> 6 ℃ above, Jingshenbuzhen, no significant loss of body fluids circumstances orbital depression, body temperature and pulse out of proportion, sweat Lin Li, pulse pressure on the poor, There should also consider the shock.

Advanced disease has become more severe, breathing rhythm is not the whole, skin mucosa cyanosis, limbs Jueleng, Zhoushen a pattern, no palpable pulse or breakdown, measurement of blood pressure lowering or not, reduce the amount of urine, unclear or consciousness to seizures, And frequently have organ failure.

Monitoring

In a simple principle, the following items through the monitoring of the estimated illness and prognosis help:

① drastic changes in temperature: T> 40 ℃ or not or, or anus that (toe) temperature> 6 ℃;

② consciousness change: indifferent, irritability, semi-conscious or unconscious;

③ blood pressure: pulse pressure <2 6kPa (20mmHg), or decreased blood pressure than the original 4 kPa (30mmHg), close to the pulse and blood pressure, pulse if the rules effectively, is also quite normal blood pressure, pulse Xiruo if they fail, blood pressure is also the majority Reduced or no measurement;

④ urine or decreased urine: urine monitoring cycle is an important indicator of the situation, oliguria means school-age children <400 ml / d, pre-school children <300 ml / d, baby <200 ml / d, 24 hours of urine <30 ~ 50m1 said no urine;

⑤ edema, usually with albumin concentrations decrease.