Zusammenfassung
Der distributive Schock ist die häufigste Art von Schock. Er wird verursacht durch eine relative Hypovolämie, die durch eine pathologische Umverteilung des intravaskulären Blutvolumens bedingt ist. Ein Grund dafür ist ein Verlust des Gefäßtonus mit Volumenverschiebung im Gefäßsystem. Ein weiterer Grund ist eine erhöhte Gefäßpermeabilität mit Volumenverschiebung in das Interstitium, auch Kapillarleck oder Capillary Leak genannt. Der distributive Schock wird in 3 Subtypen unterteilt: anaphylaktischer/anaphylaktoider, septischer und neurogener Schock.
Abstract
Distributive shock represents the most common type of shock. The source of this type of shock is a relative hypovolemia, caused by pathological redistribution of the intravascular blood volume. One reason for this pathological redistribution is a loss of vascular tone with a volume shift in the vascular system. Another reason is an increased vascular permeability with a volume shift into the interstitium, also called capillary leak. Distributive shock is divided into three subtypes: anaphylactic/anaphylactoid, septic and neurogenic shock. Anaphylactic shock is caused by massive histamine release. Food is the most common trigger in children, insect venom in adults. Adrenaline is the most important emergency drug, preferably administered i. m. Volume replacement and other medications may be required. The current Sepsis-3 criteria define sepsis and septic shock. Rapid diagnosis and therapy are crucial. In prehospital emergency medicine, treatment with balanced crystalloid
solutions is recommended. Vasopressors and inotropic drugs can be given if necessary. Currently there is generally no therapy recommendation for the prehospital administration of antibiotics. The intended hospital should be able to treat the source of infection and provide additional medical diagnostics and intensive care therapy. An imbalance between the sympathetic and parasympathetic is the cause of neurogenic shock. There are three different pathomechanisms with multiple sources of causation. The loss of vascular tone can be rapid, making volume replacement crucial. Norepinephrin can be used to increase peripheral vascular resistance tone. Alternatively, other sympathomimetics can also be used. An intended hospital should be able to treat the root cause of neurogenic shock.
Schlüsselwörter
distributiver Schock - septischer Schock - anaphylaktischer Schock - neurogener Schock - Notarzt
Key words
distributive shock - septic shock - anaphylactic shock - neurogenic shock - emergency medicine
