Distributive shock: Neurogenic Shock, Septic Shock, and Anaphylactic Shock

Medications, iodinated contrast food, and insect venom

Some things that may trigger anaphylactic shock

Neurogenic shock, septic shock, and anaphylactic shock

The three types of distributive shock

Crash cart and emergency medications and equipment

Things you should make sure are stocked and up to date prior to beginning a procedure with iodinated contrast media

Supine

Way that you should position a patient with septic shock

Most common cause of death

Describes the mortality of septic shock in the ICU

Aminophylline

IV drug that is given slowly to anaphylactic shock patient with severe bronchospasms and asthmatic symptoms to stimulate respiration and the myocardium

Chemicals released by cells

May be a cause of distributive shock because they result in vasodilation and capillary permeability prompting peripheral blood pooling

Immediately

Onset of anaphylactic shock that is a severe systemic reaction

40 - 50%

Mortality rate within 12 hours for victims of septic shock.

More rapid

Onset of anaphylactic shock that is a moderate systemic reaction compared to anaphylactic that is a mild systemic reaction

Spinal cord injuries, severe pain, neurologic damage, depressants, lack of glucose, and anesthesia

Possible causes of neurogenic shock

Raise Blood pressure

Purpose of giving vasoconstrictors to patients with anaphylactic shock

Are you allergic to any food or medicine, do you have asthma or hay fever, have you ever had hives or any other allergic skin reactions, have you ever had an exam using contrast media, and did you have a reaction during or following the exam

Questions you should ask a patient prior to beginning an exam using contrast media

Distributive (vasogenic) shock

Shock that occurs when a pooling of blood in the peripheral vessels results in decreased venous return of blood to the heart, decreased blood pressure, and decreased tissue perfusion

Written report

Should be made by a physician every time anaphylactic shock occurs

Patient's name, date, procedure, who was involved, information about contrast used, and lot number of the contrast

Some information that should be included on a patient's file and kept in a logbook to prevent and reduce the risk of anaphylactic shock

Hypotension, brachycardia, warm, dry skin, initial alertness, cool extremities, and diminishing peripheral pulses

Specific clinical manifestations of neurogenic distributive shock

Vasodilation, which results in peripheral blood pooling and contraction of smooth muscle particularly in respiratory tract

The effects of histamine and bradykinin on the body. This is what causes anaphylactic shock

Chemicals released by the body's immune response

Thing that causes the shock syndrome of a person with septic shock. These chemicals created against the bacteria increase capillary permeability and vasodilation.

Old, young, recent surgery (especially GU tract or biliary), reinsertion of urinary catheter, chronic disease (diabetes, COPD, and renal failure), immunosuppression, malnutrition, massive burns, traumatic injuries, and indwelling catheter or prosthesis

Things that cause in an increased risk of septic shock

Establish airway, possibly start CPR, use a tourniquet above injection site (to prevent absorption) Oxygen therapy, and watch for arrhythmias and arrests

Things you should do for emergency management of medical emergencies

2 hours

Time from exposure to an antigen within which anaphylactic shock that is a mild systemic reaction will occur

Septic shock

Type of distributive shock that is a systemic infection caused by bacteria

Neurogenic shock

Type of distributive shock that results from loss of sympathetic tone causing vasodilation of peripheral vessels

Epinephrine

Vasopressor drug used for emergency management of anaphylactic shock that increases blood pressure, heart rate, and cardiac output

Semi-fowlers position or sitting

Way that you should position a patient who is going into anaphylactic shock to facilitate respiration

Calm, quiet, and comfortable

Way that you should try to keep a patient with septic shock

Supine position and legs may be elevated with physicians orders

Way you should position a patient with neurogenic shock.

Return to the ER

What you should instruct a patient who has a contrast media procedure to do if they have (more) symptoms of anaphylactic shock

Move patient

What you should not do to a patient with neurogenic shock if you suspect a spinal cord injury

Lightweight blanket

What you should use to cover a patient with septic shock and whose skin is very warm

CPR

Thing that you should be especially prepared to do when caring for a person with anaphylactic shock

Anaphylactic shock

Type of distributive shock that is an exaggerates hypersensitivity to an antigen that was previously encountered by the body's immune system

Epinephrine, IV saline 0.9%, antihistamines (benadryl), aminophylline, vasoconstrictors, drugs for reduced cardiac output, short acting barbiturate,and corticosteroids

Types of drugs and medications that can be given to a patient with anaphylactic shock

30 minutes

Amount of time a patient should remain in the department for observation after a contrast media procedure if they are not an in-patient

Histamine and bradykinin

Are released in response to an antigen and can cause anaphylactic shock

Inability of blood vessels to constrict

Characteristic of all 3 types of distributive shock. This results in an inability of the blood vessels to assist in the return of blood to the heart

Same as mild systemic reaction, flushing, feeling of warmth, itching urticaria, anxiety, feeling of doom, bronchospasms, edemas of airways and larynx, dyspnea, cough, and wheezing

Clinical manifestations of anaphylactic distributive shock that is a moderate systemic reaction

All symptoms of mild and moderate reactions, decreasing blood pressure, weak, thready pulse that is either rapid or shallow, bronchospasms, laryngeal edema, severe dyspnea, cyanosis, dysphasia, abdominal cramping, vomiting, diarrhea, seizures, and respiratory and cardiac arrest

Clinical manifestations of anaphylactic distributive shock that is a severe systemic reaction. All these things can happen in seconds resulting in immediate death

Nasal congestion, periorbital swelling, itching, sneezing, nausea, vomiting, mild urticaria, tearing of eyes, peripheral tingling or itching at the site of an injection, and a feeling of fullness or tightness of the chest, mouth, or throat

Clinical manifestations of anaphylactic shock that is a mild systemic reaction

Cool, pale skin, normal or subnormal temperature, decreased blood pressure, rapid heart rate and respiration, oliguria or anuria, seizures, and organ failure (if syndrome is not reversed)

Clinical manifestations of phase 2 of septic distributive shock

Hot, dry, or flushed skin, increased heart rate and respiration, fever (possibly not in elderly patients), nausea, vomiting, diarrhea, normal to excessive urine output, and confusion (mostly in elderly patient)

Clinical manifestations of the first phase of septic distributive shock

Corticosteroids

Drugs given to patients with anaphylactic shock to suppress the immune response and decrease inflammation

Patient complains of itching, redness, or swelling of the skin or if the patient is unduly anxious

Indications that you should stop the injection or infusion immediately and notify a radiologist

Short acting barbiturate

Is given to patients with anaphylactic shock who are having convulsions