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Episode:

C is for Circulation (part 1 of 2)
Category: Science & Medicine
Duration: 00:33:48
Publish Date: 2010-08-12 10:59:01
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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.

Circulation

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Overview of Circulation (part 1) PEMcast

(CP) Introduction, disclaimer & welcome (gastro to be explored in separate episode)

Assessing circulation:

(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

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