Midterms1_Shock Flashcards
(42 cards)
The general approach to the management of patients in shock are
Assure a secure airway
Control of hemorrhage
Restoration of vascular volume and tissue perfusion
Who suggested that the organism attemtpt to maintain constancy in ythe internal environment against external forces that attempt to disrupt the milleu interieur?
Claude Bernard
He introduced tthe term “homeostasis” and emphasized that an rganism’s ability to survive was related to the maintenance of homeostasis
Walter B. Cannon
According to Alfred Blalock, shock state in hemorrhage is associated with what factor?
Reduced CO due to volume loss
This is in contrary to the previous proposal of Cannon of the toxic factor as caused of shock (secondary shock)
He proposed four categries of shock
Alfred Blolock
Hypovolemic, vasogenic, cardiogenic and neurogenic
The most common type of shock; results from loss of circulating bloo volume
Hypovolemic shock
Results from loss of whole blood (hemorrhagic shock), plasma, interstitial fluis or a combination
Type of shock that results from decreased resistance within capacitance vessels, usually seen in sepsis.
Vasogenic shock
a form of vasogenic shock in which spinal cord injury or spinal anesthesia causes vasodilation due to acute loss of sympathetic vascular tone.
Neurogenic shock
A type of shock that results from failure of the heart as a pump, as in arrhythmias or acute myocardial infarction (MI)
Cardiogenic shock
a form of cardiogenic shock that results from mechanical impediment to circulation leading to depressed cardiac output rather than primary cardiac failure.
Obstructive shock
Soft tissue and bony injury lead to the activation of inflammatory cells and the release of circulating factors, such as cytokines and intracellular molecules that modulate the immune response. This type of shock is
Traumatic shock
The phenomenon of fluid redistribution after major trauma involving blood loss is termed as
Third spacing
Core principles in the management of patients in hemorrhagic shock include
- Control of active hemorrhage
- Volume resuscitation with blood products
- Recognize and adequate hypoprerfusion correction
- Controlled fluid resuscitation
Core principles in the management of patients in septic shock include:
- Treatment/resuscitation should begin ASAP
- Identify sopecific anatimic diagnosis of infection and implement any required source control intervention as soon as medically and logistically practical
- Initiate antibiotics within 1 hour of diagnosis
- Give at least 30 ml/kg of IV crystalloid fluid within 3 hours + additional fluids
- Give vassopressors to achieve a MAP of 65 mmHG if fluid resuscitation is inadequate
Initial physiologic responses in shock are driven by
Tissue hypoperfusion and developing cellular deficit
In hemorrhagic shock, the body compenstae for the initil loss of blood volume primarily throught the
Neuroendocrince responses
## FOOTNOTE
This is the compenstated phase of shock. If cellular death and injury ensues this is called the decompensated phase of shock
This term is used to describe persitent hypoperfusion resulting in further hemodynaic **derangements* and cardiovascular collapse
Irreversible phase of shock
The goal of the neuroendocrine response to hemorrhage is to
Maintain perfusion to the heart and brain
Peripheral vasoconstriction occurs
Fluid excretion is inhibited
What stimlates the afferent signals to activate to restore homeostasis?
Loss of circulating blood volume
Thesee tracts transmit pain sensation from injured tissue which results in the action of the hypothalamic-piituitary-adrenal axis and ANS
Spinothalamic tract
Induces direct sympathetic stimulattion of the adrenal medulla to release cateecholamines
These receptors are sensitive to changes in both chamber pressure and wall stretch, and are present within the atria of the heart.
Volume receptors
These receptors are sensitive to changes in O2 tension, H+ ion concentration, and carbon dioxide (CO2) levels.
Chemoreceptors (in the aorta and carotid bodies)
Effects of chemoreceptors in the aorta and carotd bodies
Vasodilation of the coronary arteries
Slows heart rate
Vasoconstriction of the splanchnic and skeletal circ’n
It results in diminished venous return to the heart and decreased cardiac output and is compensated by increased cardiac heart rate and contractility, and venous and arterial vasoconstriction
Hemorrhage
