Shock part 1 of 6

Part 1 of 6 - Septic Shock (Distributive Shock 1 of 3)

SHOCK – classifications ( 1 of 6)

Put in the simplest way, Shock is the poor oxygenation of tissue, and cellular compromise that results.
Classified into four types:
SHOCK VIDEO

• Distributive – Sepsis, Neurogenic, anaphylactic
• Hypovolaemic
• Obstructive
• Cardiogenic

Today’s part 1 session will focus on the first of these and specifically Sepsis.
A photo is circulating the net at present. it depicts a man with severe gas gangrene to his right thigh. The story is a sad one, in that it resulted in the man’s death a short time after the image was taken, and emergency surgery had been performed.
Gas Gangrene is a fulminate anaerobic bacterial invasion of Muscle and skin tissue, resulting in characteristic discolouration and the formation of gas. The organism most responsible is Clostridia Perfringens a soil inhabiting cousin of Tetanus, and Botox.
When opportunistically invading tissue through a laceration, abrasion or the like, this anerobe produces an alphatoxin or endotoxin that vasoconstricts locally, causing tissue deoxygenation to support it’s multiplication. This results in necrosis of tissue and gas formation characteristic of the presentation.
Locallised sepsis such as gangrene causes catastrophic tissue loss, but perhaps more worrisome is the potential of septicaemia, or blood stream invasion of microbes.
This leads to Septic shock, and the topic that the rest of this Trauma Pearl will focus.
In septic shock, bacterial invasion leads to an enormous immune response to fight infection. Release of immunoglobulins other vasoactive cellular chemicals results in a global wide spread vasodilation of the venous network in the patient.
If veins dilate, the balance of blood volume left in arterial and capillary beds (where tissue oxygenation takes place) is reduced leading to hypotension (arterial) and hypoxaemia (capilliary) – Shock.
In addition, certain bacteria release endotoxins which bind to white blood cells and endothelium stimulating the release of cytokines that alter coagulation and initiate relaxation of vascular smooth muscle – Vasodilation.
The result of septic shock is that there is a wide spread maldistribution of the blood volume. This in the true sense is a distributive shock. Antibiotics do little to manage the shock once it has commenced. Judicial fluid replacement, positioning, Heparinisation, oxygen supplementation and redistribution using vasopressors continues to be the side game while assisting the patient to fight infection.
Sadly, septic shock has a poor prognosis, and nurses, paramedics and doctors should understand that all trauma patients are somewhat immunicompromised and at risk of developing septic shock, if not from their injuries, then from the myriad of invasive procedures we perform in haste to support A, B , Cs.

Check out the video summary
or read through the other 5 parts to the 6 episode series.
2 - Neurogenic Shock
3 - Anaphylaxis
4 - Hypovolaemic Shock
5 - Obstructive Shock
6 - Cardiogenic shock


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