Distributive Shock
Types of DISTRIBUTIVE shock
What are neurogenic shock, anaphylactic shock, septic shock, capillary leak syndrome? Neural induced or chemical induced.
Distributive shock occurs when blood volume is not LOST but is DISTRIBUTED to the interstitial tissues where it cannot perfuse organs.
Burns STARTS as a distributive shock and leads to hypovolemic shock.
9th ed pg 753
10th ed pg 733-735
Disease processes that increase the risk of cardiogenic shock.
What are valvular problems, cardiomyopathy, myocardial infarction, and sudden cardiac death from ventricular dysrhythmias?
Common problems leading to hypovolemic shock.
What are dehydration and hemorrhage from trauma or surgery?
9th ed pg 752
10th ed. pg 733
Conditions predisposing a patient to sepsis and septic shock.
What are malnutrition, immunosuppression, large open wounds, exposure to invasive procedures, cancer, alcoholism?
Table 37-4 9th ed pg 762
Table 34-4 10th ed pg 743
Lab values to expect during the resuscitation (first 24-48h) phase of a burn.
What are elevated potassium (from tissue destruction and RBC hemolysis), decreased sodium (trapped in edema fluid and lost through plasma leak), low pH (metabolic acidosis), elevated BUN (result of fluid volume loss)?
Emergent symptoms that indicate neurogenic shock for those with a spinal cord injury above T6
What are hypotension and BRADYCARDIA.
9th ed pg 898
10th ed pg 881
Three main causes of obstructive shock
What are cardiac tamponade, pulmonary embolism, and tension pneumothorax?
Priority interventions for hypovolemic shock.
What are ensure patent airway, insert or maintain IV catheter, administer oxygen, elevate the patient's feet keeping HOB flat or elevated to no more than a 30 degree angle?
Best Practice Box
9th ed. pg 759
10th ed pg 739
Symptoms of SIRS
What are temp more than 101 F or less than 96.8 F, HR more than 90, RR more than 20, abnormal WBC, SBP less than 90, MAP less than 70, UOP less than 0.5ml/kg/hr despite adequate fluid resuscitation?
Table 37-3 9th ed pg 762
This indicates pulmonary injury after a burn.
What is a change in respiratory pattern- develop brassy cough, drool or have difficulty swallowing, produce sounds on exhalation like wheezes or stridor?
Action Alert Box
9th ed pg 491
10th ed pg 465
Priority interventions in anaphylactic shock
What are assess respiratory status, call RRT, have intubation or trach equipment ready, apply O2 at 100% via non rebreather, give epinephrine IM?
9th ed Best Practice Box pg 365
10th ed pg 351
Symptoms of obstructive or cardiogenic shock.
What are hypotension (SBP less than 90mmHg), tachycardia, urine output less than 30ml/hr, cold clammy skin with poor peripheral pulses, tachypnea?
Symptoms of hypovolemic shock in the initial stage
What are a decrease in the MAP of 5-10mmHg from baseling, increased sympathetic stimulation, mild vasoconstriction, and increased heart rate?
Table 37-2 9th ed pg 754
Table 34-2 10th ed pg 735
Within the first hour, what should be done for the patient identified as septic or meeting SIRS criteria?
What are measure serum lactate, obtain blood cultures before administering antibiotics, administer broad spectrum antibiotics, administer 30ml/kg crystalloids intravenously for hypotension or elevated lactate?
Table 37-5 9th ed pg 765
Table 34-5 10th ed 745
General management for all types of burns.
What is assess for airway patency, administer O2 as needed, cover the patient with a blanket, keep the patient NPO, obtain vitals, initiate IV, and perform head to toe assessment?
Best Practice Box
9th ed pg 489
Medications given for neurogenic shock
What are dopamine for BP as well as dextran (volume expander) and atropine for bradycardia?
9th ed pg 898
10th ed pgs 881-882
Interventions for cardiogenic and obstructive shock.
What are apply oxygen, call RRT if not in the ICU, IV morphine, possible intubation and mechanical ventilation, and treatment if the reason for the shock?
Vasopressors and positive inotropes can be given to maintain organ perfusion but these drugs INCREASE myocardial oxygen consumption and can worsen ischemia. Use with extreme caution.
9th ed. pg 782
10th ed. pg 765-766
Drug therapy used in hypovolemic shock when volume loss is severe.
What are dopamine, norepinephrine, and phenylephrine?
These drugs increase venous return.
Chart 37-4 9th ed pg 759
10th ed pg 740
Abnormalities that can cause bleeding during severe sepsis.
What are microvascular changes and widespread use of clotting factors leading to the formation of many small clots (DIC)?
9th ed pg 765
10th ed pg 745
Signs and symptoms of compartment syndrome.
What are the 6 Ps? Pain, pallor, pulselessness, paresthesia, paralysis, poikilothermia. This happens with full thickness wounds and the patient will require an escharotomy or fasciotomy to relieve the pressure and allow normal blood flow.
9th ed pg 484
True or False- Most deaths from anaphylaxis are related to a delay in epinephrine administration.
What is true?
Critical Rescue Box
9th ed pg 365
10th ed. pg 351
Treatment for specific cardiogenic or obstructive shock.
What are (CARDIOGENIC) defibrillate for sudden cardiac death from vfib/pulseless VT; revascularize for myocardial infarction; transplant for cardiomyopathy; replace or repair faulty valve; (OBSTRUCTIVE) thrombolytics, embolectomy, or anticoagulation for pulmonary embolism; chest tube for tension pneumothorax; pericardiocentesis for cardiac tamponade?
True or false: The progressive stage of shock is a life-threatening emergency.
What is true?
The patient's life can usually be saved if the conditions causing the shock are corrected within 1 hour or less of the onset of the progressive stage. Once shock moves in to the refractory stage, vital organs have extensive damage and cannot respond effectively to interventions and shock continues. Therapy will not be effective in saving the patient's life.
9th ed Action Alert pg 755
10th ed Action Alert pg 736
True or false: We give low dose steroids during the sepsis treatment period.
What is somewhat true? The stress of severe sepsis can cause adrenal insufficiency. IV hydrocortisone and PO fludrocortisone will be given if this occurs.
9th ed pg 765
10th ed pg 745
These medications should be given before procedures on a burn unit.
What are opioid analgesics IV?
9th edition pg 496