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
