Distributive Shock

Question 1

What causes distributive shock

Answer 1

Causes by profound arterial and venous dilation resulting in a marked reduction in systemic vascular resistance

Question 2

What are the most common causes of distributive shock

Answer 2

1. Sepsis MC)
2. Anaphylaxis
3. Neurogenic
4. Drug effects

Question 3

How does dissociative shock present as

Answer 3

1. Normal heart function
2. Intact and responsive blood vessels
3. Adequate blood supply
   *caused by CO poisoning, cyanide poisoning, anemia

Question 4

Why do perfusion problems occur in dissociative shock

Answer 4

Perfusion problems occur because the blood has a decreased ability to carry oxygen to the tissues

Question 5

What is the definition of sepsis

Answer 5

Infection + Systemic inflammatory response syndrome (SIRS)

Question 6

What is indicates positive SIRS

Answer 6

2 or more
1. Temp (>38 (100.4) <36 (96.8))
2. HR >90
3. RR >20 or PACO2 <32mm Hg
4. Abnl WBC >12,000 or <4,000 or >10% immature bands

Question 7

What is the definition of severe sepsis

Answer 7

Sepsis + organ dysfunction + hypoperfusion

Question 8

What is the definition of septic shock

Answer 8

Sepsis +refractory hypotension desire fluids, lactate above 4 and end organ damage

Question 9

What happens to circulation during sepsis

Answer 9

1. Hypovolemia
2. Myocardial depression
3. Increased pulmonary vasculature resistance
4. Deficits in micro circulation

Question 10

What can deficits in micro circulation lead to

Answer 10

1. Regional ischemia of organs
2. Organs especially vulnerable

Question 11

What does an increased of lactic acid cause

Answer 11

1. Decreased cell membrane function
2. Increased intracellular sodium and calcium
   *third-space fluid accumulation, fluids migrates into cells, GI tract secondary to inflammation

Question 12

What is the diagnostic studies findings of lung and urine

Answer 12

Lung
*CXR
Urine
*oliguria
*prerenal state results

Question 13

What is the diagnostic studies findings of hematologic

Answer 13

1. Increased WBC (young bands)
2. Leukopenia
3. Decreased platelets (Increasde PT, PTT, D Dimer)
4. Increased hemoglobin (fluid sequestrations causes hemoconcentration)

Question 14

What is the diagnostic studies findings of chemistries

Answer 14

1. Increased glucose
2. Decreased calcium
3. Metabolic acidosis
4. Increase in lactic acid

Question 15

What is the etiology of septic shock

Answer 15

Gram negative rods

Question 16

What are the two phases of septic shock

Answer 16

Early
*high output
Late
*low output

Question 17

What happens during the early phase of septic shock

Answer 17

1. Red skin
2. Elevated or decreaed temperature
3. Increased respiratory rate and depth
4. Cardiac output normal or decreased

Question 18

What happens during the late phase of septic shocks

Answer 18

1. Hypotension
2. Confusion
3. Poor capillary refill
4. Low urine output
5. Easy bruising, bleeding or Frank hemorrhage

Question 19

What is the treatment of septic shock

Answer 19

1. Restore CO thru volume replacement
   *central venous and arterial monitoring
2. Use vasopressors if replacement response inadequate
3. Early endotracheal intubation
4. Empiric ATB within the 1st hour

Question 20

When are broad coverage ATB started for the treatment of septic shock

Answer 20

Immediately after obtaining cultures