Chapter 47
Shock, Multiple Organ Dysfunction
Syndrome, and Burns in Children
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Shock and Multiple Organ
Dysfunction Syndrome (MODS)
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Shock
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Commonly results from hemorrhage, severe
dehydration, progressive heart failure, or sepsis
Compensated shock
Decompensated shock
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Shock
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Hypovolemic shock
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Distributive or vasogenic shock
Neurogenic shock
Cardiogenic shock
Septic shock
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Shock

Dehydration, hypovolemia, low cardiac output
stimulate adrenergic and renal compensation

Tachycardia
 Redistribution of blood from the skin, gut, and kidney to
the brain and heart
 Reduced renal perfusion stimulates the reninangiotensin-aldosterone system, resulting in renal
sodium and water retention

Neonatal and young infant kidneys are incapable
of excreting concentrated urine

Compensatory mechanisms are relatively ineffective
during the first weeks of life
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Reperfusion Injury


Cellular damage caused by the restoration
and reperfusion of oxygen to cells that have
been exposed to reversible hypoxic
conditions
Occurs from the generation of highly reactive
oxygen intermediates

The amount of free oxygen radical production
depends on the severity and duration of the
ischemic period
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Evaluation of Shock
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
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Arterial blood gas (ABG)
Serum lactate concentration
Blood pressure
Ventilation and oxygenation
Chemistry analytes


Electrolytes, glucose, BUN, liver function, calcium,
phosphorus, cardiac enzymes
Hemoglobin and hematocrit
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Treatment of Shock
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
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Adequate oxygen delivery
Monitor body temperature
Transfusion of blood components
IV fluids (volume resuscitation)
Monitor urine output and specific gravity
Monitor blood pressure
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Emerging Therapies for
Shock and Sepsis
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
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Injury prevention
Haemophilus influenzae and Neisseria
meningitidis vaccines
Colony-stimulating factors to increase white
blood counts in immunocompromised
individuals
Infectious disease control
Resuscitation techniques
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Emerging Therapies for
Shock and Sepsis
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Mediator-specific therapies
Continuous plasma filtration
Glucocorticoid administration
Activation of Toll-like receptors
Genetic profiling
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Multiple Organ Dysfunction
Syndrome (MODS)



Failure of at least two organs that results from a
single cause
Risk factors: sepsis, trauma, cardiopulmonary
arrest, congenital heart disease, liver/bone marrow
transplantation
Children with chronic diseases have an increased
risk and increased mortality
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Burns


A common result of inadequate supervision,
curiosity, inability to escape the burning
agent, or intentional abuse
Child abuse


6% to 20% of child burn injuries are child abuse
Pattern burns, forced emersion burns, splash/spill
burns, cigarette burns
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Burns
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Scald injuries
Contact burns
Flame burns
Electrical burns
Chemical burns
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Severity of Injury


Total body surface area (TBSA)
Rule of nines inaccurate in children
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


Arms and trunk demonstrate same proportions as an
adult
Head and neck—18%
Each lower extremity—14%
Depth of injury

Infant skin is extremely fragile and more likely to
sustain a deeper burn
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Severity of Injury

Age
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Younger than 2 years, a significantly higher risk for
associated morbidity and mortality
Have not achieved maturity of immune system and
are at increased risk for infection and sepsis
Very young children are intolerant of rapid fluid shifts;
immature renal function negatively affects ability to
retain sodium and water
Areas of the body burned
Secondary injuries and manifestations
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Burn Injury in Children
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Integumentary system
Cardiovascular system
Renal system
Gastrointestinal system
Metabolism
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Burn Injury in Children
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Immune function
Scar maturation
Burn shock
Pulmonary system
Infection
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Burn Injury in Children

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Functional limitations
Fluid resuscitation
Wound management
Pulmonary support
Nutritional support
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Burn Injury in Children


Comfort management
Community reintegration
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