Warm periphery is noticed in which type of shock: September 2012

Ans. B i.e. Septic shock Distributive shock Peripheral vasodilatation and subsequent maldistribution of blood flow. This leads to a relative hypovolaemia. Common examples of this type being septic, anaphylactic and neurogenic shock. Septic shock It includes vasodilatation, high cardiac output, and loss of intravascular volume due to 'leaky capillaries'. The patient may sta with a low cardiac output due to the leaky capillaries with loss of fluid and because the vasodilated aerial tree requires a larger blood volume to fill it (relative hypovolaemia). With appropriate fluid volume replacement the hea will pump against lower resistance and therefore there will often be an increase in cardiac output in order to compensate for the reduction in SVR. The patient may remain hypotensive but will have warm peripheries and a bounding pulse. The bounding pulse is a reflection of the wide pulse pressure which is due to a low diastolic pressure. Due to toxins and acidosis, sepsis may have a negative inotropic affect on the hea as well as causing vasodilatation and the patient can therefore have a low cardiac output and a low SVR.