Cardiovascular circulation

Secondary assessment

The box below gives common symptoms and signs which should be sought in the cardiovascular system. Emergency investigations are suggested.

Symptoms

Signs

Breathlessness

Tachycardia

Fever

Bradycardia

Palpitations

Abnormal pulse volume or rhythm

Feeding difficulties

Abnormal skin perfusion or colour

Cyanosis

Hypotension

Pallor

Hypertension

Hypotonia

Abnormal ventilation rate or depth

Drowsiness

Hepatomegaly

Fluid loss

Auscultatory crepitations

Oliguria

Cardiac murmur

Peripheral oedema

Raised jugular venous pressure

Investigations

Urea and electrolytes, arterial blood gas, ECG, chest X-ray (selective), full blood count, blood

culture (selective)

• Further boluses of fluid should be given to shocked children who have not had a sustained improvement to the first bolus given at resuscitation. Consider inotropes and intubation with the third bolus.

• Consider IV antibiotics in shocked children with no obvious fluid loss. Sepsis is likely.

• If a patient has a cardiac arrhythmia the appropriate protocol should be followed.

• If anaphylaxis is suspected in a shocked patient adrenaline should be given intramuscularly in a dose 10 micrograms/kg, in addition to fluid boluses.

• Consider duct-dependent congenital heart disease in infants with unresponsive shock. Give alprostadil.

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