Week 4 - Distributive Shock

Question 1

Distributive Shock is AKA ________________

Answer 1

AKA: Vasogenic Shock

This is a SHOCK of the blood vessels and the inability of the body (veins / arteries) to VASOCONSTRICT. The vasodilation permits the blood to distribute into incorrect places in the body (usually our periphery) —leading to a DECREASED PRELOAD, Decreased Stroke Volume, Decreased Cardiac output

Question 2

what is Distributive Shock?

Answer 2

Wipespread Vasodilation and increased capillary permeability

*Neurogenic, septic, anaphylactic shock

Because the BLOOD VOLUME does NOT change–relative hypovolemia results

Question 3

What is Relative Hypovolemia

Answer 3

Inadequate distribution of blood volume between the central and peripheral compartments

_Because of vasodilation it appears that the our blood volume is decreased–even though we didnt lose any volume

Question 4

Causes (2) of Distributive Shock (overall)

Answer 4

1) Loss of sympathetic tone

2) Release of biochemical mediators (ie, histamine) from cell

Question 5

most common type of SHOCK and IN HOSPITAL SHOCK across the board

Answer 5

SEPTIC SHOCK

Question 6

Most common cause of death in the ICU

Mortality rate of 40-70%

Answer 6

SEPTIC SHOCK

Question 7

Type of Shock that initiates activation of biochemical response and systemic inflammatory response

Answer 7

Septic Shock

Question 8

What happens with Septic Shock?

include the “three” defining points

Answer 8

activation of biochemical response and systemic inflammatory response
1) Increased capillary permeability-leaky cells

  2) widespread vasodilation
  3) Activation of clotting / fibrinolytic cascade

Question 9

Medical Management (4) of Septic Shock

Answer 9

1) Cardiopulmonary Support
-FLUID REPLACEMENT (essential)
30 ml/kg of fluid over 30-60 minutes
If MAP <60 or hypotensive (from baseline value)
Vasoconstrictors are then added!

2) Identify and eliminate cause of infection
- collect cultures first
- antiobiotic therapy

3) Glucorticoids (hydrocortisone)
- pts with septic shock show better response with it

4) Control Fever
- dont want their body working extra hard

Question 10

Nursing Management (4) of SEPTIC Shock

Answer 10

1) Identify High Risk Patients
- Immunocompromised
- Indwelling lines
- invasic procedures
- debilitated

2) Assess perfusion status / intervene PRN
- Titration of meds

3) Prevent infection
- handwashing
- aseptic technique for invasive procedures
- proper use of central lines

4) Monitor responsiveness to interventions
- Improved CVP
- MAP > 60
- LOC
- Urine Output
- Pulses

Question 11

Type of shock that results from the loss of balance between the parasympathetic and sympathetic–resulting in vasodilation

Answer 11

NEUROGENIC SHOCK

Question 12

Causes (4) of Neurogenic Shock

Answer 12

1) Spinal cord injury (above T6)
2) Spinal Anesthesia
3) head injury
4) Nervous System Damage

Question 13

Sympathetic vs Parasympathetic

Answer 13

Sympathetic = “fight or Flight”

Parasympathetic = “Rest and Digest”

Question 14

Neurogenic shock signs and symptoms

Answer 14

Hypotension with bradycardia

Warm, dry skin

Question 15

Treatments for Neurogenic Shock

Answer 15

1) Restore sympathetic tone with vasopressors

2) Increase HR with atropine

Question 16

Type of Shock caused by severe allergic reaction and affects Airway, Breathing and Circulation

Answer 16

Anaphylactic Shock

Question 17

what does Histamine do in the body?

Answer 17

Vasodilation (Epinepherine causes vasoconstriction)
Cardiac Depression (Epi causes cardiac stimulation)
Bronchospasm (Epi causes Bronchial relaxation)

Question 18

S/S of Anaphylactic Shock (4)

Answer 18

1) severe bronchospasm
2) Urticaria
3) angioedema (swelling in face, tongue)
4) profound hypotension

Question 19

Medical / Nursing Management

Anaphylactic Shock

Answer 19

1) Remove causative agent

2) Medications
Fluids: 2 L of crystalloids
First Line agent: Epinepherine Pen
H1 and H2 antagonist: (histamine blocking)
Bronchodilator (Relaxes the airway)
Corticosteroids: (to decrease inflammation)

3) Emergency support (airway protection)
4) Check for allergies and / or possible reaction to blood products
5) education on avoiding future exposure

Question 20

ANAPHYLACTIC SHOCK:

FLUID…

First line tx (medication)

Second Line Tx (medications)

Answer 20

1) FLUID:
- -2 L of Crystalloids (IV)

2) 1st line tx:
- -Epinephrine (IM) if not in shock

3) 2nd line tx:
- -Epinephrine (IV) if pt is in shock

Question 21

NEUROGENIC SHOCK

FLUID…

First line tx (medication)

Second Line Tx (medications)

Answer 21

1) FLUID:
- -2 L of Crystalloids (IV)

2) 1st line tx:
- - Norepinephrine,
- -Vasopressin

3) 2nd line tx:
- -Phenylephrine (monitor for reflex bradycardia)

Question 22

SEPTIC SHOCK

FLUID…

First line tx (medication)

Second Line Tx (medications)

Answer 22

1) FLUID:
- -30 mLs / kg over 30-60 minutes

2) 1st line tx:
- - Norepinephrine,

3) 2nd line tx:
- -Dopamine
- -Epinephrine
- -Vasopressin (if catecholamine resistant)
- -Phenylephrine (combined w/initial agent-or given alone if tolerated)