distributive shock

Question 1

What is distributive shock (definition)?

Answer 1

Relative hypovolemia due to intravascular volume redistribution from loss of vascular toneor increased capillary permeability.

Question 2

What types of distributive shock exist?

Answer 2

Neurogenic, Anaphylactic, Septic.

Question 3

What common feature unites distributive shock types?

Answer 3

Intravascular volume maldistribution (not always actual loss of total body fluid).

Question 4

What causes neurogenic shock?

Answer 4

Hemodynamic consequence of spinal cord injury or spinal anesthesia causing loss of sympathetic outflow.

Question 5

When can neurogenic shock occur and for how long?

Answer 5

Can occur within 30 minutes of spinal cord injury and may last up to 6 weeks.

Question 6

Which spinal levels are usually involved in neurogenic shock?

Answer 6

Cervical or high thoracic injuries.

Question 7

What is the pathophysiology of neurogenic shock?

Answer 7

Loss of SNS tone → massive vasodilation → pooling of blood → hypotensionand often bradycardia.

Question 8

What is unique about heart rate in neurogenic shock?

Answer 8

Bradycardia is typical — it’s the only shock type commonly with bradycardia due to lost sympathetic tone.

Question 9

What are clinical manifestations of neurogenic shock?

Answer 9

Hypotension, bradycardia, difficulty with temperature regulation, bowel/bladder dysfunction, skin perfusion changes (cool or warm, dry skin), deficits tied to level of injury.

Question 10

How is neurogenic shock treated?

Answer 10

Treat cause (spinal stability and precautions), then manage hypotension/bradycardia: vasopressors(phenylephrine) to maintain BP, atropine for bradycardia.

Question 11

How should fluids be given in neurogenic shock?

Answer 11

Cautiously — hypotension isn’t due to true volume loss; avoid fluid overload.

Question 12

What else must be monitored in neurogenic shock?

Answer 12

Temperature regulation and hypotonic dysfunction.

Question 13

What is anaphylactic shock?

Answer 13

An acute, life-threatening hypersensitivity reaction to a sensitizing antigen (drug, food, insect venom, vaccine) causing massive vasodilation and increased capillary permeability.

Question 14

What routes of exposure can cause anaphylaxis?

Answer 14

Injection (IM), inhalation, ingestion, topical — IM (e.g., bee sting, vaccine) often produces severe responses.

Question 15

How quickly does anaphylaxis require action?

Answer 15

Immediate action is needed to prevent progression to anaphylactic shock.

Question 16

What are the pathophysiologic changes in anaphylaxis?

Answer 16

Release of vasoactive mediators → massive vasodilation and capillary leak → fluid shifts out of vascular space.

Question 17

What are hallmark respiratory manifestations of anaphylaxis?

Answer 17

Laryngeal edema, severe bronchospasm, respiratory distress, wheeze, stridor, and possible airway compromise.

Question 18

What are other common clinical manifestations for anaphylactic shock?

Answer 18

Dizziness, chest pain, incontinence, swelling of lips/tongue, flushing, pruritus, urticaria (hives), angioedema, anxiety/confusion, sense of impending doom.

Question 19

What is first-line medication for anaphylactic shock?

Answer 19

Epinephrine (IM or SQ outside of a code).

Question 20

Why avoid IV epinephrine except in code situations?

Answer 20

IV epi in non-arrest can cause severe cardiac complications.

Question 21

What adjunctive meds help in anaphylaxis?

Answer 21

Diphenhydramine, H2 blockers (e.g., famotidine) to block histamine; corticosteroids to reduce inflammation.

Question 22

What airway measures are used for anaphylaxis?

Answer 22

Maintain airway: nebulized bronchodilators, aerosolized epinephrine, ET intubation if needed.

Question 23

What is the fluid strategy for anaphylaxis?

Answer 23

Aggressive crystalloids to counter vasodilation and capillary leak.

Question 24

What key history item helps prevent anaphylaxis?

Answer 24

Prior allergic history — identify triggers to avoid.

Question 25

What defines septic shock?

Answer 25

A subset of sepsis with profound circulatory, cellular, and metabolic abnormalities leading to persistent hypotension and increased mortality.

Question 26

What precedes septic shock?

Answer 26

Infection → sepsis → septic shock.

Question 27

What pathogens can cause septic shock?

Answer 27

Gram-negative & Gram-positive bacteria, and sometimes parasites, fungi, or viruses.

Question 28

How often is a causative agent not identified in sepsis?

Answer 28

Approximately 30% of cases have no identified causative organism.

Question 29

What are common clinical manifestations of septic shock?

Answer 29

Persistent hypotension despite fluids, tachycardia, dysregulated temperature (high or low), decreased ejection fraction, GI issues (paralytic ileus, GI bleed), altered LOC, ↓ urine output.

Question 30

What severe peripheral complications can occur in septic shock?

Answer 30

Ischemic necrosis of extremities (fingers, toes, nose) due to poor perfusion.

Question 31

What laboratory abnormalities occur in septic shock?

Answer 31

Elevated lactate, elevated blood glucose, decreased platelets, positive blood cultures (if identified), abnormal WBC (high/low), elevated procalcitonin, increased urine specific gravity.

Question 32

What is initial fluid resuscitation in septic shock?

Answer 32

30 mL/kg isotonic crystalloid (initial bolus).

Question 33

What is the target MAP when resuscitating septic shock?

Answer 33

MAP ≥ 65 mmHg.

Question 34

What if hypotension persists after fluids in septic shock?

Answer 34

Start vasopressors — norepinephrine is first-line.

Question 35

What other vasoactive agents are used for septic shock?

Answer 35

Epinephrine, dobutamine (to increase O₂ delivery), and add others if needed.

Question 36

When should broad-spectrum antibiotics be started?

Answer 36

Within the first hour of recognizing sepsis/septic shock — obtain cultures before antibiotics if feasible.

Question 37

What glucose control target is recommended in septic shock?

Answer 37

Maintain glucose < 180 mg/dL.

Question 38

What prophylactic measures are indicated in septic shock?

Answer 38

Stress ulcer prophylaxis (PPI such as pantoprazole) and VTE prophylaxis(heparin or enoxaparin).

Question 39

What is the main treatment principle for septic shock?

Answer 39

Treat underlying infection, restore intravascular volume, maintain perfusion (vasopressors), and support organ systems.

Question 40

Which shock types usually get aggressive fluid resuscitation?

Answer 40

Hypovolemic, septic shock, and anaphylactic require aggressive fluids.

Question 41

Which shock types should fluids be given cautiously or avoided aggressively?

Answer 41

Cardiogenic and neurogenic shock — avoid overloading as the problem isn’t primarily low volume.

Question 42

Which shock is associated with bradycardia?

Answer 42

Neurogenic shock (unique among shock types).

Question 43

Which shock type commonly uses norepinephrineas first-line vasopressor?

Answer 43

Septic shock (if hypotension persists after fluids) and often used in cardiogenic cases post-MI.

Question 44

What bedside marker signals poor tissue perfusion across shock types?

Answer 44

Elevated lactate (indicator of anaerobic metabolism).

Question 45

What is the nursing priority across all shock types?

Answer 45

Early recognition, maintain airway/oxygenation, support circulation (IV access, fluids/vasopressors as appropriate), monitor urine output and mental status, and treat the underlying cause.