Understanding Distributive Shock CEN Review 2018

WHAT IS DISTRIBUTIVE AND ANAPHYLACTIC SHOCK?

Distributive shock is defined as an abnormal distribution of intravascular volume as a result of (1) decreased sympathetic tone, (2) increased vascular permeability, (3) pooling of blood in venous, capillary beds. What does this mean? The heart (pump) and volume (blood) is adequate, but the fluid is not in the right place.

There are three types of distributive shock

  • Anaphylactic
  • Septic
  • Neurogenic

Anaphylactic Shock is defined as an often severe and sometimes fatal reaction in a susceptible individual upon exposure to specific antigen after previous sensitization that is characterized especially by respiratory symptoms, fainting, itching, and hives. ANAPHYLAXIS IS NOT THE SAME AS ANAPHYLACTIC SHOCK. ANAPHYLAXIS IS A NORMAL CIRCULATION WITH RISK OF PROGRESSION TO ANAPHYLACTIC SHOCK.

WHAT CAUSES ANAPHYLACTIC SHOCK?

Exposure to an antigen

  • Shellfish
  • Nuts (peanuts)
  • Dairy (milk, eggs)
  • Soy
  • Wheat
  • Insects
  • Medications
  • Iodine
  • Latex
  • Exercise Induced
  • Cold Exposure




 

ANAPHYLACTIC SHOCK MANIFESTATIONS

  • Symptom onset begins with cutaneous manifestations
    • Hives, pruritus, erythema
  • Rapidly progressive symptoms
    • Dyspnea, cough, throat, tightness, stridor
    • Wheezing, bronchospasm
    • Syncope
    • Chest tightness, palpitations
    • Angioedema
    • Hypotension, Tachycardia
    • Respiratory and Cardiac Arrest

ANAPHYLACTIC SHOCK INTERVENTIONS

  • With any form of shock: ALWAYS DETERMINE THE CAUSE OF ANAPHYLACTIC SHOCK AND REMOVE THE CAUSE
  • Airway Management
    • High Flow Oxygen
  • IV Access
    • Fluid resuscitation
    • Vasopressors for hypotension
  • Medications
    • IM epinephrine 1:1000, repeat in 15 to 20 minutes if needed (First Line)
    • IV epinephrine 0.1-0.5 Ml 1:10,000 if needed
    • Inhaled Beta 2 agonists (albuterol)
    • Antihistamine therapy
      • H1 and H2 blockers – Benadryl, Zyrtec, Allegra, Claritin
    • Corticosteroids
  • Admission to Hospital
  • Epinephrine auto-injector with teaching upon discharge