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Vietnam US in Shock 2019
Vietnam US in Shock 2019
of Shock In Children
Chor Yek Kee
Sarawak General Hospital
Shock
Definition of shock
Acute and complex state of circulatory dysfunction that
result in failure to deliver sufficient amount of oxygen and other
nutrients to meet tissue metabolic demand
Categories Of Shock
1. Hypovolemic
2. Cardiogenic
3. Obstructive
4. Distributive
5. Septic
6. Endocrine
The Late Dr Max Harry Weil
The father of Critical Care Medicine
• In 1972,Weil and Shubin described
• shock as a pathophysiological response,
• proposed a classification system that we are
using today.
•Windows into body
• Altered mental status
• Orthostatic blood pressure
• Capillary refill time
• Subungual perfusion measurement
• Cold limbs
• Lung crackles
• Narrow pulse pressure
The New Window Into Body
Important Message Before We Start
• Ultrasound cannot take the place of good history and
physical nor essential lab and diagnostic studies
9 10 M - 5,6,7
A -8
5 4
6 10. Aortic P
arch and IJC- 9,10
7
RUSH Ultimate Aim
•Pump Diagnosis
• Fluid
• Inotropes
•Tank And
Treatment • Antibiotic
•
•Pipe strategies
•
Prostin
Procedure
Drain
Operation
HI-MAP Sequencing for RUSH
H - 1,2
I - 3,4
10
8
9 10 M - 5,6,7
A -8
5 4
6 10. Aortic P
arch and IJC- 9,10
7
Heart
1. Pericardial Space
2. Myocardium Wall Thickness
3. Cardiac Contractility
4. Cardiac Rhythm
5. Chamber Size
6. Valves
7. Coronary artery
Pericardial Effusion
Hypertrophied myocardium
Cardiac Contractility
Cardiac Contractility
Cardiac arrhythmia
Chamber size
Chamber size
Chamber size
Valves
Valves
Coronary Arteries
ALCAPA
Anomalous Left Coronary Artery From Pulmonary Artery
HI-MAP Sequencing for RUSH
H - 1,2
I - 3,4
10
8
9 10 M - 5,6,7
A -8
5 4
6 10. Aortic P
arch and IJC- 9,10
7
Inferior Vena Cava
Spontaneous Spontaneous Ventilated
inspiration forced exhalation Inspiration
Inferior Vena Cava
Collapsible Non- collapsible
Inferior Vena Cava
Inferior Vena Cava
SPONTANEOUS BREATHING
Collapse index > 50%
- likely hypovolaemia
-CVP < 10
Intubated
Distention Index >20 % in ventilated child
- maybe fluid responsive
Inferior Vena Cava
Inferior Vena Cava
HI-MAP Sequencing for RUSH
H - 1,2
I - 3,4
10
8
9 10 M - 5,6,7
A -8
5 4
6 10. Aortic P
arch and IJC- 9,10
7
Morrison Pouch/FAST
Traumatic
Morrison Pouch/FAST
Traumatic
Morrison Pouch/FAST
Non traumatic
Morrison Pouch/FAST
non-traumatic
HI-MAP Sequencing for RUSH
H - 1,2
I - 3,4
10
8
9 10 M - 5,6,7
A -8
5 4
6 10. Aortic P
arch and IJC- 9,10
7
Internal Jugular Vein
Internal Jugular Vein
Aortic Arch
• Obstructive shock
• Coarctation of Aorta
• Interrupted Aortic Arch
Normal Aortic Arch
Coarctation of Aorta
Coarctation of Aorta
HI-MAP Sequencing for RUSH
H - 1,2
I - 3,4
10
8
9 10 M - 5,6,7
A -8
5 4
6 10. Aortic P
arch and IJC- 9,10
7
Pulmonary edema
Pulmonary Edema
Normal Lung Pneumothorax
Lung Point
ULTRASOUND OF
PNEUMOTHORAX Absence of
sliding sign
Lung Pneumothorax
A line
Pneumonia
Subpleural consolidation Shred Sign Hepatization/ total
lung consolidation
Pneumonia
Air bronchogram in the consolidated lung
Large Pleural effusion
Jelly Fish sign :
Massive Pleural Effusion
Exudative fluid with fibrin
Empyema
Case 1
History
• 3 years old boy, sitting between parents in a
motorbike
• Knocked down by lost controlled car
• Child was threw out 300m away from the scene
• No eye witness
• Resuscitated at district hospital
• Arrive to PICU after 3 hours journey
HI-MAP Sequencing for RUSH
H - 1,2
I - 3,4
10
8
9 10 M - 5,6,7
A -8
5 4
6 10. Aortic P
arch and IJC- 9,10
7
Concusion?
Thanks