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Flashcards in Week 4 - Distributive Shock Deck (22)
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1

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

2

what is Distributive Shock?

Wipespread Vasodilation and increased capillary permeability

*Neurogenic, septic, anaphylactic shock

Because the BLOOD VOLUME does NOT change--relative hypovolemia results

3

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

4

Causes (2) of Distributive Shock (overall)

1) Loss of sympathetic tone

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

5

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

SEPTIC SHOCK

6

Most common cause of death in the ICU
Mortality rate of 40-70%

SEPTIC SHOCK

7

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

Septic Shock

8

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

9

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

10

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

11

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

NEUROGENIC SHOCK

12

Causes (4) of Neurogenic Shock

1) Spinal cord injury (above T6)

2) Spinal Anesthesia

3) head injury

4) Nervous System Damage

13

Sympathetic vs Parasympathetic

Sympathetic = "fight or Flight"

Parasympathetic = "Rest and Digest"

14

Neurogenic shock signs and symptoms

Hypotension with bradycardia

Warm, dry skin

15

Treatments for Neurogenic Shock

1) Restore sympathetic tone with vasopressors

2) Increase HR with atropine

16

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

Anaphylactic Shock

17

what does Histamine do in the body?

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

18

S/S of Anaphylactic Shock (4)

1) severe bronchospasm

2) Urticaria

3) angioedema (swelling in face, tongue)

4) profound hypotension

19

Medical / Nursing Management
Anaphylactic Shock

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

20

ANAPHYLACTIC SHOCK:

FLUID...

First line tx (medication)

Second Line Tx (medications)

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

21

NEUROGENIC SHOCK

FLUID...

First line tx (medication)

Second Line Tx (medications)

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

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

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

22

SEPTIC SHOCK

FLUID...

First line tx (medication)

Second Line Tx (medications)

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)