How to Spot Distributive Shock Symptoms
Distributive shock is when an abnormality of the small blood vessels leads to an improper distribution of blood throughout the body. This can cause life-threatening signs of shock and an impaired delivery of oxygen to the body's vital organs. To spot distributive shock, you will need to know the general signs and symptoms of shock to look out for. You will also need to know what, specifically, can cause distributive shock (as opposed to other forms of shock). Determining the underlying cause of distributive shock is key to effectively managing it, and to having the best chances of saving the person's life. If you are worried that you or someone else is showing signs of distributive shock, proceed to the Emergency Room immediately.
Assessing the Symptoms
Check for an elevated heart rate.All types of shock, including distributive shock, typically present with a faster than normal heart rate (over 100 beats per minute). You can take someone's pulse, or listen to their heart with a stethoscope, to determine their heart rate.
- In distributive shock, when you feel the pulse at the person's extremities (wrists and/or ankles), you are likely to feel a "bounding pulse."
- A bounding pulse is a stronger, more forceful pulse than normal.
- It is due to the increased total blood volume in distributive shock, from the vasodilatory effects that occur in sepsis or anaphylaxis (among other things).
- The bounding pulse may be felt early, but as the shock progresses, the pulse will become weak or absent in the extremities.
Observe an increased respiratory rate.In addition to an elevated heart rate, all types of shock also typically present with rapid respiration. This is because the fundamental problem in shock is lack of oxygen delivery to the body's vital organs. Therefore, the body tries to compensate for the lack of oxygen by breathing more rapidly.
- Greater than 20 breaths per minute is considered an elevated respiratory rate.
Feel for warm extremities.In distributive shock specifically (which includes septic shock), a person's extremities (hands and feet) will typically be warmer than usual. This is because distributive shock, perhaps counter-intuitively, presents with more blood than normal in the circulatory system; however, the blood is "distributed" inappropriately throughout the body, leading to inadequate circulation to the vital organs and excess blood flow to the extremities and to areas of the body that do not need it.
Notice decreased urination.In shock, because the body perceives a lack of effective blood flow and oxygenation, it will seek to conserve fluids. As a result, urine output will decrease, leading to infrequent urination.
Evaluate for a fever.Because infection ("sepsis") is the number one cause of distributive shock, it is key to test for the presence of a fever. A temperature greater than 38 degrees Celsius (100.4 degrees Fahrenheit) may be indicative of an infection.
- A temperature less than 36 degrees Celsius (96.8 degrees Fahrenheit) is also of concern, as sometimes the body can present with a reduced temperature rather than with a fever.
Look for signs of confusion.Shock typically presents with confusion, and often with a decreased level of consciousness. This is due to the decreased effectiveness of blood flow and oxygenation throughout the body. In more severe cases, the person may even be unconscious.
Measure blood pressure.In shock, the blood pressure is lower than normal. It is typically below 90 mm Hg systolic, and it may even be undetectable. In distributive shock, even though more blood than normal is shunted to the extremities (the arms and legs), the blood vessels have dilated and, as such, the blood pressure reading still tends to be low.
Assessing the Patient's Medical History
Take note of an infection preceding the onset of shock.The number one reason for someone to go into distributive shock is due to an infection that gets worse and spreads to the bloodstream (called "sepsis"). Therefore, if you are trying to recognize distributive shock, ask about and assess for any recent or current infections.
- The most common infections that can lead to shock include pneumonias, genitourinary infections, and abdominal infections.
Consider the possibility of anaphylaxis.Another reason for someone to go into distributive shock is due to anaphylaxis - a systemic allergic reaction, which may occur in response to a bee sting or other allergy. People often carry an "epipen" (epinephrine pen) if they have been diagnosed with allergies that may lead to anaphylaxis and/or distributive shock. Inquire if there was exposure to a triggering allergen before the onset of shock.
Assess for other common causes of distributive shock.Other common causes of distributive shock include "SIRS" (systemic inflammatory response syndrome), pancreatitis, kidney problems (called "Addisonian crisis"), burns, toxic shock syndrome (most common in women who are menstruating who have left a tampon in for too long), and "neurogenic shock" (a subtype of distributive shock caused by a spinal cord injury that results in decreased blood vessel tone).
Performing Diagnostic Tests
Test for lactic acidosis.A blood test for lactate can indicate the presence of lactic acidosis. Lactic acidosis is an indication that the body's vital organs are not getting enough blood flow and oxygen, which, if not resolved, could lead to multi-organ failure.
- The degree of lactic acidosis, therefore, is a way to measure the severity of shock symptoms.
Evaluate white blood cell counts.Measuring white blood cells via a blood test is also very helpful in assessing for the presence of an infection, which is the leading cause of distributive shock. White blood cells can also be elevated in other inflammatory conditions that may underlie distributive shock.
- If an infection ("septic shock") is suspected as the cause of distributive shock, blood cultures can also be taken.
- A blood culture can grow the bacteria or other microbe that is causing the infection, allowing doctors to choose an appropriate antibiotic (or other antimicrobial agent, depending upon the cause of the infection) for treatment.
Assess vital organ function.Because the consequence of shock that is trying to be avoided is vital organ failure, it is key to assess the function of vital organs. Organs to test include:
- Kidney function
- Liver function
- Heart function
- Pancreas function, as pancreatitis can actually be a cause of distributive shock
Opt for other diagnostic tests as needed to determine the underlying cause.If distributive shock (or any other form of shock) is suspected or diagnosed clinically, it is key to identify the underlying cause so that it can be resolved. Additional diagnostic tests that may be of use include a chest x-ray and/or a CT scan, among other things.
- Further tests will be ordered depending on the suspected etiology, for example, if pneumonia is suspected, a sputum culture and Gram stain may be ordered as well.
Begin treatment.If shock is confirmed, the patient must be treated in the intensive care unit (ICU) of a hospital. The underlying cause must be treated as the patient is stabilized with oxygen. Vital signs and fluid intake and outtake should be measure hourly.
Video: Neurogenic shock | Circulatory System and Disease | NCLEX-RN | Khan Academy
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