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.
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?
Conditions predisposing a patient to sepsis and septic shock.
What are malnutrition, immunosuppression, large open wounds, exposure to invasive procedures, cancer, alcoholism?
The most frequent and life threatening complication of an aneurysm.
What is rupture?
It leads to abrupt and massive hemorrhagic shock.
Emergent symptoms that indicate neurogenic shock for those with a spinal cord injury above T6
What are hypotension and BRADYCARDIA.
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?
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?
The most common cause of aneurysms.
What is atherosclerosis?
Also hypertension, hyperlipidemia, and cigarette smoking.
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?
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?
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?
If rupture of abdominal aortic aneurysm is suspected, assess for these signs and symptoms, then notify the physician immediately.
What are severe sudden pain in the lower back or abdomen, that can radiate to the groin, buttocks, or legs; hematoma on the flanks; abdominal distension; oliguria; diaphoresis; hypotension; loss of peripheral pulses; dysrhythmias?
Medications given for neurogenic shock
What are dopamine for BP as well as dextran (volume expander) and atropine for bradycardia?
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
Drug therapy used in hypovolemic shock when volume loss is severe.
What are dopamine, norepinephrine, and phenylephrine?
These drugs increase venous return.
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)?
The most common symptoms for an aortic dissection.
What is "sharp", "stabbing", "ripping", "tearing" pain that can move from its point of origin?
Diaphoresis, nausea, vomiting, faintness, and apprehension are also common.
Commonly, aortic regurgitation, which is characterized by a murmur heard along the right sternal border, can be auscultated.
True or False- Most deaths from anaphylaxis are related to a delay in epinephrine administration.
What is true?
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.
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.
Interventions for emergency care in the patient with aortic dissection.
What are increased comfort with morphine, reduction in SBP and HR with a beta blocker like esmolol and possibly nicardipine for SBP control, 2 large bore IVs, indwelling urinary catheter for strict I/Os?