Pediatric emergency medicine trisk 0269 0269

Neurogenic Shock . Assess for evidence of spinal cord injury or severe
traumatic brain injury.
Anaphylaxis . The provider should determine by history whether the patient
has any known or suspected allergies to food, medications, or environmental
allergens, as well as evaluate for the following physical findings:
HEENT: Facial or mouth/tongue swelling
Cardiac: Poor perfusion, hypotension as above
Respiratory: Respiratory distress, wheezing, stridor
Skin: Urticarial rash
Septic Shock . The provider should determine by history whether the patient
has any underlying conditions which may predispose them to septic shock
including neonatal age, innate or acquired immunodeficiency or
immunosuppression (including malignancy, sickle cell disease and other causes of
asplenia, bone marrow or solid organ transplant), or the presence of an indwelling
central venous catheter or other invasive hardware. In addition, they should
evaluate carefully for evidence of end-organ dysfunction on physical examination
as described by organ system below (and summarized in Table 10.2 ):
Cardiac: Poor perfusion (diminished or bounding pulses, flash capillary refill or
delayed [>3 seconds] capillary refill, abnormally cool or warm extremities,
mottling)
Respiratory: Tachypnea (from lung infection and/or metabolic acidosis), signs
of respiratory distress or failure
Hematologic: Rashes suspicious for disseminated intravascular coagulation
such as petechiae or purpura; or a toxin-mediated process manifested as
erythroderma
Neurologic: Altered mental status
Renal: Decreased urine output
POCUS findings: Early findings may overlap with hypovolemic shock with
evidence of fluid responsiveness (measured by respiratory variation in IVC
diameter in the longitudinal view) and normal or hyperdynamic ventricular
function. Myocardial dysfunction may evolve with evidence of ventricular

dysfunction. Repeated assessment can be helpful.
Diagnostic Testing in Septic Shock
Laboratory testing in suspected septic shock is focused on determining evidence
of end-organ dysfunction and recommended testing is listed by organ system