Week 4 - Distributive Shock Flashcards
Distributive Shock is AKA ________________
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
what is Distributive Shock?
Wipespread Vasodilation and increased capillary permeability
*Neurogenic, septic, anaphylactic shock
Because the BLOOD VOLUME does NOT change–relative hypovolemia results
What is Relative Hypovolemia
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
Causes (2) of Distributive Shock (overall)
1) Loss of sympathetic tone
2) Release of biochemical mediators (ie, histamine) from cell
most common type of SHOCK and IN HOSPITAL SHOCK across the board
SEPTIC SHOCK
Most common cause of death in the ICU
Mortality rate of 40-70%
SEPTIC SHOCK
Type of Shock that initiates activation of biochemical response and systemic inflammatory response
Septic Shock
What happens with Septic Shock?
include the “three” defining points
activation of biochemical response and systemic inflammatory response
1) Increased capillary permeability-leaky cells
2) widespread vasodilation 3) Activation of clotting / fibrinolytic cascade
Medical Management (4) of Septic Shock
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
Nursing Management (4) of SEPTIC Shock
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
Type of shock that results from the loss of balance between the parasympathetic and sympathetic–resulting in vasodilation
NEUROGENIC SHOCK
Causes (4) of Neurogenic Shock
1) Spinal cord injury (above T6)
2) Spinal Anesthesia
3) head injury
4) Nervous System Damage
Sympathetic vs Parasympathetic
Sympathetic = “fight or Flight”
Parasympathetic = “Rest and Digest”
Neurogenic shock signs and symptoms
Hypotension with bradycardia
Warm, dry skin
Treatments for Neurogenic Shock
1) Restore sympathetic tone with vasopressors
2) Increase HR with atropine