Distributive Shock (Neurogenic, Chemical, Obstructive)

Distributive/ Circulatory Shock

• Pump problem?

• Volume problem?

• It is a Vasculature problem!

Distributive/ Circulatory Shock (Patho.)

• Event

• Vasodilation

• Inflamm. response

• Misdistribution

• Decreased Pre-load

• Decreased CO

• Inadequate perfusion

Distributive/ Circulatory Shock (Neural Induced)

• Neurogenic

Distributive/ Circulatory Shock (Chemically Induced)

• Sepsis

• Anaphylaxis

• Capillary Leak

Neurogenic Shock

• Occurs due to massive vasodilation as a result of loss of the sympathetic tone

Neurogenic Shock (Causes)

• Spinal cord injury

  • T6 & above

• Spinal anesthesia

• Drugs

  • Ganglionic blocking agents

  • Barbiturates

• Brain damage

  • Medulla

  • Rare

Neurogenic Shock (Compare & Contrast w/ Hypovolemic Shock)

• B/P

• HR

• Extremities

• Thermal regulation

Neurogenic Shock (Tx)

• Fluid

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• O2

• Vasoconstricting Drugs

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  • Norepinephrine (Levophed)

  • Epinephrine

Anaphylactic Shock

• Sudden life-threatening hypersensitivity reaction to an antigen

• Characterized by massive vasodilation & increased capillary permeability

Anaphylaxis (Patho.)

• Chemical mediators cause:

  • Vasodilation

  • Capillary permeability

  • Bronchoconstriction

  • Increased coronary permeability

Anaphylaxis

• Shock from profound vasodilation & low cardiac output

• Death can result from severe hypoxemia secondary to bronchoconstriction or from cardiovascular collapse

Anaphylaxis (S/S)

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Anaphylaxis (Tx)

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