Distributive Shock, - 9c. Responding to Distributive Shock, Pediatric Advanced Life Support (2018)

This video discusses the second type of shock, Distributive. The three types of distributive shock and their unique characteristics are explained here. Distributive shock can also be categorized into warm and cold shock, depending on the type of shock being experienced by the individual.

"Distributive shock is a condition in which the majority of blood is inappropriately distributed in the vasculature.

A common way to conceptualize distributive shock is as a condition in which the vasculature has relaxed and dilated to the point of inadequacy. The arterial blood supply needs to maintain a certain tension in order to maintain blood pressure. Likewise, the venous system must maintain tension as well, so as not to retain too much of the total blood supply.

In distributive shock, the blood is not being maintained in the required and needed useful blood vessels. Distributive shock is most commonly caused by sepsis, anaphylaxis, or a neurological problem, all of which cause vascular dilation or loss of blood vessel tone. In distributive shock, the preload, contractility, and afterload vary depending on the etiology.
Distributive shock is difficult to recognize because the signs and symptoms vary greatly depending on the etiology. Common symptoms include tachypnea, tachycardia, low to normal blood pressure, decreased urine output, and decreased level of consciousness.

The three types of distributive shocks are septic shock, anaphylactic shock, and neurogenic shock.

In septic shock, there is decreased preload, normal or decreased contractility, and the afterload varies.

In anaphylactic shock, there is a decreased preload, contractility varies, and the afterload is low in the left ventricle and high in the right ventricle.

In neurogenic shock, there is decreased preload, normal contractility, and decreased afterload.

Distributive shock is further categorized into warm and cold shock. If the individual is experience warm shock, they commonly will have warm, erythematous peripheral skin and wide pulse pressure in the setting of hypotension. If the individual is experiencing cold shock, they commonly will have pale, vasoconstricted skin and narrow pulse pressure hypotension. In each case, distributive shock is generally considered when the individual is likely to have one of the three main causes: sepsis, anaphylaxis, neurological problem."

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