[Treatment of acute circulatory failure (shock) in childhood]

Abstract

The concept of shock is discussed emphazising the microcirculatory disturbance implied with the resulting failure in tissular perfussion and its consequences (hypoxia, acidosis, enzymatic damage, metabolic changes). Its causes are outlined (cardiogenic, hypovolemic, septic, neurogenic, anaphylactic, endocrine); its phases, vasoconstriction, precapillary dilatiation and pooling, disseminated intravascular coagulation and hemorrhages following hypocoagulability due to an excessive consumption of factors and the fundamental elements of the clinical picture. Treatment is analyzed outstanding the necessity of an adequate and urgent correction of the disturbance in volume, stressing the importance of supplying about 400 ml. x m-2 during the first hour and the necessary monitoring of central venous pressure as the best index to control perfussed fluids. Indications for electrolytic solutions are given, including blood, platelets, plasms, albumin, dextran and manitol. The fact that respiratory failure following "shock lung" is stressed as the main cause of death and the different procedures of management are described (ventilation, intubation, oxygen therapy, tracheostomy, mechanical ventilation and use of respirators, specially the Bird type). Vasodilator drugs are described together with their indications; also, contraindications of vasoconstrictive drugs. Several complications, such as disseminated intravascular coagulation, acute adrenal failure, acute renal failure and arrhythmia are mentioned together with basic elements for prevention and treatment. Emphasis is placed on the serial control of several elementsusing a special counter in their outline: sensory, respiration including type, rythm and rate, cyanosis, central venous pressure, pulse, color of the skin, capillary filling, temperature, arterial pressure, diuresis, weight, and hydration. A careful hydrous balance is stressed. It is handled in the same counter