Could your blood flow be impaired and you're going into 'shock'? Let's talk about 'distributive shock'!

Oh, sometimes we can suddenly get into a big trouble, right? There are times when we feel like we're losing our life and it's hard to breathe. At times like these, something serious might be happening inside our bodies. Today we're going to talk about one such sudden, life-threatening condition. That's a condition called 'Distributive Shock' .

What is this 'distributive shock'? Simply put...

Simply put, distributive shock is a medical emergency. What happens here is that the blood vessels in your body (where blood flows) suddenly become too large, like a rubber tube being stretched. Sometimes this is also called vasodilatory shock . So, when the blood vessels become large like this, the blood pressure suddenly drops a lot. Think of it like if a water pipe gets bigger, the water will flow slower.

What happens when this happens? Your major organs, like your heart, brain, and kidneys, don't get enough blood . Not only that, but sometimes some of the blood starts to leak out of these tiny blood vessels (capillaries). This can cause the amount of blood in your body to decrease. This is a very dangerous situation, because our organs need a constant supply of blood to function.

Very important: If you experience a 'shock' like this, it is important to seek treatment as soon as possible. Otherwise, it can be life-threatening.

What are the main types of 'distributive shocks'?

There are three main types of 'distributive shock', each of which occurs for a different reason.

1. Septic Shock: This is the most common type. It is caused by a bacterial infection. Imagine, you have a wound, it gets really bad, the germs spread throughout your body, and it becomes a state called ``Sepsis'', and you can't control it. Sometimes, even something like pneumonia can cause this condition.

2. Anaphylactic Shock: This is caused by a severe allergic reaction. For example, some people have a severe allergic reaction to something like peanuts, right? Or it happens when they get bitten by some insects. A person with asthma can also have this condition, even if they have very severe difficulty breathing.

3. Neurogenic Shock: This is caused by damage to your spinal cord. For example, if you hit your head while jumping into water and injure your spinal cord, or if you have a serious accident that damages your spine, this 'neurogenic shock' can occur due to the effect on the nervous system.

What is the difference between 'Distributive Shock' and 'Hypovolemic Shock'?

Both are types of 'shock'. That means that in both cases, our vital organs are not getting enough blood and oxygen. However, the cause is different.

• Distributive shock , as mentioned earlier, is caused by the blood vessels becoming too large. This is often caused by an infection called sepsis or a severe allergic reaction.
• Hypovolemic shock is when the amount of blood or other fluids in the body is too low. For example, this can happen if you lose a lot of blood from a major injury, or if you lose a lot of fluid from severe diarrhea or vomiting.

Simply put, in 'distributive' the blood vessels become larger, in 'hypovolemic' the blood/fluid in the body decreases. Got it?

How common is this 'distributive shock'?

There are four types of shock that we know of (`Hypovolemic`, `Cardiogenic Shock`, `Obstructive Shock` and `Distributive Shock`). Of these four , the most common is `Distributive Shock` . Especially the type called `Septic Shock`. Even in a country like America, about a million people develop `Septic Shock` every year. It can happen to anyone.

What happens to the body with 'distributive shock'?

As I mentioned before, when blood vessels become too large, blood pressure decreases. Then the amount of blood going to the organs becomes insufficient. Our organs are like machines. They need to get the right amount of fuel (i.e. blood and oxygen) to work. When they don't get enough blood, oxygen, and nutrients, the organs gradually start to stop working. We call this 'organ failure' . If the organs fail like this, it becomes a major threat to life.

What are the symptoms of this?

The symptoms of distributive shock can vary slightly depending on the cause. However, there are some common symptoms:

• Skin rash
• Rapid heartbeat and breathing
• Low blood pressure (this is the main symptom)
• The hands and feet are initially warm, then become cold and sweaty.
• Fever
• Chills (feeling cold and shivering)
• Stomach ache
• Confusion, feeling like you're losing consciousness
• Cough
• Shortness of breath
• Nausea
• Vomiting
• Pain when urinating

If one or more of these symptoms appear suddenly, it's best not to take it lightly, right?

What are the causes of 'Distributive Shock'?

In addition to the three types we discussed earlier, there are several other reasons that lead to this situation.

• Sepsis caused by a bacterial infection (this is the main cause)
• Anaphylaxis, which is caused by severe allergies (e.g., foods like peanuts, insect stings, certain medications, asthma exacerbations)
• Burns
• Pancreatitis
• Toxic Shock Syndrome (which can occur, especially in women, due to tampon use)
• Spinal cord injury
• Endocrine disorders
• Adrenal insufficiency (this is a little less common)
• Capillary leak syndrome ( leakage of fluid from blood vessels, this is also a little less common)
• Taking too much of a blood vessel-enlarging medication (Drug overdose) (this is also rare)

How do doctors recognize this?

When you have these symptoms, the first thing a doctor will do is examine you thoroughly and ask you about your medical history. However, a person in shock may not be able to give you any information. In such a situation, someone with you can tell the doctor about your allergies, whether you have had anaphylaxis before, and what medications you are taking. This information can be very helpful in diagnosing the condition.

After that, the doctor will order several tests, such as:

• Blood tests: Check for infections and how the organs are functioning.
• ECG (Electrocardiogram - EKG): Checks the functioning of the heart.
• Chest X-ray: Check the condition of the lungs.
• Ultrasound scan: Look at the heart, lungs, and organs in the abdomen. Some of these can be done at the bedside.

How is it treated?

Because this is an emergency, treatment often begins in the Emergency Room. After that, you may be transferred to the Intensive Care Unit (ICU).

1. The first thing you do is give IV fluids. Fluids like saline are given into a vein. This is done to slightly lower your blood pressure.

2. Next, we will determine the cause of the 'shock' and give the appropriate medication.

3. Sometimes , tube feeding may be used , because the body needs energy.

In the intensive care unit, doctors and nurses will continue to monitor your vital signs (heart rate, blood pressure, breathing, temperature). They will also check for side effects from the treatment. If you have difficulty breathing on your own, you may be connected to a breathing machine (ventilator) .

What kind of medications are used?

The medication given for 'Distributive Shock' varies depending on the cause:

• Vasopressors:These are given to increase blood pressure. For example, medicines like `epinephrine`, `vasopressin`, `norepinephrine` or `phenylephrine`.
• Antibiotics : If there is an infection.
• Antihistamines: If it is due to an allergic reaction.
• Steroids: For allergies or severe sepsis.
• Albuterol inhaler (such as Accuneb® or Proair®HFA): If the shock is due to asthma.

Are there any side effects of the treatment?

Yes, some medications can cause minor side effects.

• Vasopressors: irregular heartbeat (arrhythmia), restlessness, pulmonary edema, chest pain, narrowing of the coronary arteries of the heart (this can lead to a heart attack).
• Antibiotics : Nausea, vomiting.
• Albuterol: Anxiety, dizziness, nausea.
• Antihistamines: Drowsiness, dizziness, headache, rapid heartbeat.

But, doctors will look at all of this and give you the most appropriate treatment. The most important thing is to save your life.

How do we reduce this risk?

We may not be able to avoid everything that causes distributive shock. For example, infections and burns. However, there are some things we can do to reduce the risk of this shock due to certain known issues:

• If you have a severe food allergy , such as peanuts, always carry an epinephrine auto-injector (such as an EpiPen® Auto-Injector or Adrenalin®) with you. Know exactly how to use it.
• If you have frequent asthma flare-ups , keep your albuterol or salbutamol inhaler with you at all times. Don't let it run out.
• If you use tampons, don't leave them in too long, as this can cause Toxic Shock Syndrome, which can progress to Distributive Shock.
• Do not jump into shallow water or water of unknown depth. It can cause spinal cord damage.
• If you are taking medications that dilate (open) your blood vessels, do not take too much of them. Take only the amount your doctor tells you to take.

What happens if a 'distributive shock' occurs?

If the cause of shock is sepsis, you may have long-term problems. Things like fatigue, bad dreams, and loss of appetite. Whatever the cause, you should continue to see your doctor for follow-up appointments. You should also take the medications your doctor prescribes exactly.

The time it takes to recover from distributive shock depends on how severe it was. You may need to stay in the hospital for a few days to a few weeks.

The survival rate for this condition can vary from 20% to 80%, depending on the cause. If left untreated, it can often lead to death. Early diagnosis and treatment are the best way to save a life. The elderly, those who drink alcohol, and those with multiple organ problems are at higher risk.

If your body responds well to IV fluids and your organs continue to function, you have a good chance of recovering.

How do I take care of myself after I get home?

After you get home from the hospital, take care of yourself as your doctor tells you. You may need to stay home for a few days or weeks to rest well before you can go back to work. Keep your follow-up appointments. Take your medications exactly as prescribed.

If you feel like you're having trouble again while at home, call your doctor immediately.

In an emergency: Anyone with symptoms of distributive shock should be taken to the emergency room immediately. Until the ambulance arrives, have the person in shock lie down. Cover them with a blanket to keep them warm, and elevate their legs about a foot to improve blood circulation.

What questions should you ask the doctor?

If you experience this condition, it's a good idea to ask your doctor about things like:

• Am I at risk of developing 'distributive shock' again?
• How often do I need to come for follow-up appointments?
• Will I have long-term effects from the 'Distributive Shock'?

Finally, what to remember (Take-Home Message)

Distributive Shock is a medical emergency that requires immediate treatment. Getting help as soon as possible is your best chance of saving your life. It takes time to recover, so be patient with yourself. While at home, take your medications exactly as prescribed by your doctor, and go to follow-ups regularly. As you can see, this is a very serious condition. So it's important to be aware of this.

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