Shock

Question 1

ولقد كنتُ في حلاوة طلَبِ العلم أَلْقى من الشَّدائد ما هو أحلى عندي من العسَل في سبيل ما أطلبُ وأرجو، وكنتُ في زمن الصِّبا آخذُ معي أرغفةً يابسة، ثم أذهب به في طلب الحديث، وأقعد على نهر عيسى، ثُم آكل هذا الرَّغيف، وأشرب الماء، فكلَّما أكلتُ لقمةً شربتُ عليها
إن الله كتب الإحسان علي كل شئ

Give defintion to Circulatory SHOCK .

Answer 1

It isdecreased perfusion to the tissue and the blood oxygen and nutrients epscailly the vital organan like brain hindring tissue from doing theri metabolic functions

Question 2

Types of SHOCK ?

نمت وأدلج الناس !

Answer 2

Hypovolemic cold shock
Low resistance shock decrased TPR ( Vasogenic ,distributive shock)
Cardiogenic shock
other shocks

Question 3

The ABP is not a measuer for tissue perfusion why?

Answer 3

this is becasue decreasing in abp casue reflex vasoconstriviton casuing decreasing blood perfusion of tissue woeseining shock

Question 4

Explain hypovolemic shock .

Answer 4

It is shocke due to decrease in blood volume due to
1-Hemorrhage
2-Vomitting and diarrhea
3-burns
this decreases MCP and VR and COP DECRASING ABP
The compensatory mechanism by/??\
vc of splanchnic git and skeletal vessels
عشان يوفر الدم للقلب والدماغ !
causing cold pain skin

Question 5

Cardiogenic shock definition

Answer 5

A shock resulted from weakness of the pump function of the hear despite good VR and filling but the COP is reduced like in massive myocardial infarction
the compensatory mechanism is VC of cutanuous blood vessel leaving cold pale skin

Question 6

Low resistance shock mean ?

Answer 6

it is a shock not due to blood volume or pump prboelms but becasue VD of peripheral vasculture casuing decreasing TPR and incrasing vascular capacitness anddecrasing mean circulatory pressure
calle warm shock caues the extremities are not cold as hypovolemic shock
both MCP AN TPR 
MEANT VR AND COP AND MAP 
'
its casuses are diveded into 
1-neurogenic 
2-anaphylactic

Question 7

Deep general anethesia and shock ?>

Answer 7

it casuses depression of the VMC neurogenic shock low resistence

Question 8

spinal shock explain.

Answer 8

shocke due to loss of sympathatic tone due spinal anethesia or spinal cord lesion blocking the sympathatic out flow to vessels and the vc tone decreasing TPR and MCP and COP ABP
POTENT CAUSE OF NEUROGENICS

Question 9

Brain damage can cause shock ?

Answer 9

yes in case of brain damage contusion or concussion to the basal are there is ischemia and stimulation of VMC incresing ABP 5-7minutes if prolonged this leads to inactivation of VMC tpr and cop and abp casuing neurogenic shock

Question 10

Define/generalized vasodilation

Answer 10

a case caused by the symphatatic cholinergic fibers of hypothalamus and this leads to genral VD decreasing TPR ABP NEUROGENIC SHOC K

Question 11

Mention neurogenic shock

Answer 11

-deep general anethesia
-spinal shock
-brain damage
-generalized VD
GBS DEEP

Question 12

Discuss Anaphylactic shock as atype of low resistance shock

Answer 12

When a person is sensitized to antigen and reexpoed to it this leads to
degranulation of Mast cells and Basophils releasing histamine VD substances
causing arterilodilation and capillary shift fluid casuing hypovolemia

the hypotension may be severe casuing circulatory collapse
incompitable blood transfusion

Question 13

How does septic shock take the characatetstics of other 3 types of shock ?

Answer 13

Septic shock is in case of sepsis = septicemia the bacatrail infection + its endotoxins running in blood casuing fever and increased tissue demands from o2 and nutrient
it is like :بيضرب مساحة الوعاء والقلب كذلك
1-low resistance shock becasue toxins casue generalized VD decrasigng TPR and VR and causing decreased ABP and low perfusion يقلل سرعة وصول الدم للانسجة
يزود الدم للانسجة الميتة والتعبانة ويقلله للانسجة السليمة
Hypotension is due decrased both MCP and TPR Dure to vasodilation on veins and arteries
2-hypovolemic shock : the vasodilation of arteriole increases pressure in capillaries casuing fluid shif into ISF
3-Cardiogenic shock : toxins casue cardiac depression

Question 14

Explain traumatic shock ?

Answer 14

Occur when there is sever damadge to tissue like bonea and muscles in wars or accidents causing
internal bleeding or external hemorrahge :hypovolemic shock
the severe pain casues neurogenic shock

Question 15

combination of shocks in Surgical shock mention

Answer 15

surgical shock in case of surgical operation causing
hypovolemic shock : internal bleeding +external hemorrhage
low resistance shock neurogenic: due to severe pain
dehydration

Question 16

Stages of shock mention

Answer 16

-Non progrssive compensated no tratment spontanupusly
progressive decompensated treatment aid
Refractory there is no use , treatment no recovery

Question 17

Cardiogenc and low resistance shock cannot be compensated GR.

Answer 17

becasuse compensatory depednds on heart and vascular respones

Question 17

Cardiogenc and low resistance shock cannot be compensated GR.

Answer 17

becasuse compensatory depednds on heart and vascular respones

Question 18

GR/ Hypovolemic shock can be compensated ?

Answer 18

this is due to no problems in the heart or vessels

and the compensatory mechansimsd epednds on heart and vascular respones

Question 19

Define non progressive shock ?

Answer 19

it is compensated ! where the circulatory compensatory mechanisms can work to return the normal state of circulation wihtout aid from the out side by
incraseing ABP immediate Onset
Increasing BV delayed onset

Question 19

Define non progressive shock ?

Answer 19

it is compensated ! where the circulatory compensatory mechanisms can work to return the normal state of circulation wihtout aid from the out side by
incraseing ABP immediate Onset
Increasing BV delayed onset

Question 20

Define progressive shock ?>

Answer 20

Decompensated in which

the the shock without outside treatment will lead to worsen of the state till death

Question 21

The irrversible shock?

Answer 21

Refractory shock which even if you give the patient treatment is is no use and he will die even in the moment the patient is still alive

Question 22

Discuss decompensatory mechanisms .

Answer 22

There is decrased in MAP 
and this leads to inteses sympatahtic activity and its vasoconstriction but ! 
still the Organ blood flow is low ?  
this affect vital organs as follow:
 The Heart > Myocardial failure 
the Git and Liver > 
1-Mycoardial depressant >Myocardial failure 
2-accumulation of toxins 
The kidney
Electorlyte imbalance 
the other organs 
acidosis VD mechanisms 

A-the affect on heart dierctly and by the myocardial depressant from pancreas casuser myocardial failure decreasing COP AND MAP
B-the effect of
accumulation of toxin
Electorlyte imbalance especially hyperkalemia >arryhtmia
acidosis VD mechanisms
periciptate :
1-Myocardial failure > dec cop > MAP
2-decrasinG Venous tone and MCP and VR and COP
3- DECRASING Artriolar tone decraesing the TPR AND MAP
AND CAPILLARY FILTRATION DECREASING VR and cop

Question 23

إن من أول ما أدرك الناس من النبوة الأولي إن لم تستح فاصنع ما شئت

Answer 23

-الحديث يمكن ان يشير الي معنيين الاول : انه ان لم يكن عند الانسان الحياء فانه يفعل ما يشاء سواء كان مخزيا او ليس من المرؤة او كان منها الثاني: هو انه اذا كان ماتفعل فعل لا يستحيي منه فافعله ولا تبالي -الحديث فيه دليل علي بقاء اثار الامم السابقة ومن سبق من الانبياء الحياء شعبة من شعب الايمان منه حياء لله وحياء للعباد الحياء من الله هو ان يراك حيث امرك وان يفقدك حيث نهاك الحياء من العباد هو فعل ماهو من المروءة فمثلا لو كنت في الصف الاول وممدت قدميك فهذا ليس من المروء ولكن لوكنت في وسط اصحابك فهذا ليس فيه حياء

Question 24

عن ابي عمرة سفيان بن عبدالله رضي الله عنه قال قلت لرسول الله "يارسول الله قلي لي في الاسلام قولا لا اسال عنه احدا غيرك قال :قل آمنت بالله ثم استقم "

Answer 24

هاتان الكلمتان جمعا الدين كله امنت بالله فيه القول باللسان والقلب استقم فيه العمل بالجوارح وهذا يشمل اساس الدين الاخلاص والمتابعة !

Question 25

إن الحلال بين وإن الحرام بين وبينهما أمور متشابهات من لايعلمهن كثير من الناس فمن اتقي الشبهات فقد استبرئ لدينه وعرضه ومن وقع في الشبهات وقع في الحرام كالراعي يرعي حول الحمي يوشك ان يقع فيه الا و ان لكل ملك حمي ألا وإن حمي الله محارمه إلا وإن في الجسد مضغة اذا صلحت صلح الجسد كله واذا فسدت فسد الجسد كله ألا وهي القلب

Answer 25

``` يوشك ان يقع فيه لان راعي البقر لو رعي حول حمي مخضرة فتوشك البهائم ان تدخل ذاك الحمي ومن الصعب ان تخرجها كذلك الانسان الطواف حول المتشابهات فانه يوشك ان يقع في الحرام وصعب ان يخرج منه اسباب المتشابهات قلة العلم قلة الفهم التقصير في التدبر سوء القصد والتعصب ! هذا الاشتباه لايكون علي جميع الناس ```

Question 26

adveres effects of ARBS ?

Answer 26

``` Well Tolerated than ACEI Hanuta Hyperkalemia anigoedma unsafe to fetus taste disturbance aucte renal failure in case or renal hypo perfuysiom ```

Question 27

Non progressive shock in detail

Answer 27

It is the hypovolemic shock and it is compensated by the mechanisms succeeding in reutrining cop to normal value and recovery and this is by ? Short term and long mechanisms in restoring ABP nhiniton of Baroreceptors impulses due to hypotension sensation ! Stimulation of chemoreceptors stimulatrion of CNS ischemic respone all cause stimulaiton of VMC casuing increasr VC of peripheral and increasing cardiac propertirs -angionteni2 and Vasopressin due to renal hypoperfusion renin ! Renal and hormonal Short term and long compensatory mechanisms in restoring blood volume Capillary fluid shift and Labile tissue and liver proteins to plasma increasing osmolarity and absorption from ISF AND Contraction of splenic capsule 1- thrist ang2 and hormonal water conservation 2- plasma proteins replaced by liver 3-RBCS replaced by Bone marrow

Question 28

Progressive decomensated shock in detail ?

Answer 28

This is when compenstaion fails decompensation begins! cerebral ischemia causes inhibtion of the VMC and casuing inhibtion of the sympathtaic activity and vc and cardiac propertits and map Heart is affected due to decline in the properties due to less perfusion to heart and due to - vmc and due to myocardial depressant by pancreas due to its ischemia and this decrease the cop and map the Git and liver affected causing accumulation of toxin and ther role in depression of heart , venodilation and decrasing vr and cop and arterioldialtion and decraing tpr so map Kideny electrolyte disturbance casuing arrythmia and its role in 3 the other organs causing lactica acidosis and it has rule in heart depression and venulodilation and arterioldilation and decraeaing MAP In case of decompensated shock hypercoasulability occur illustrate ? This is due to ischemic toxins and and sluggish blood flow leads to coronary thromobosis and cardiac ischemia and MI Hypoxia Hyperthermia may pericptate thrombosis

Question 29

Artrioldilation mechanism in decompensation

Answer 29

it casued by the \ cerberal ischemia decrasing the VMC and Sympathatic activit accumulation of toxin of liver kideny electrolye disturbance organs lactica acidosis results in ! 2? 1- dec TPR and MAP 2-iNCREASING CAPILLARY SHIFT FLUID DECRASING VOLUME AND CARDIAC OUTPUT

Question 30

Cerebral ischemia as decompensation mechanism ?

Answer 30

cerebral ischemia causes inhibtion of the VMC and casuing inhibtion of the sympathtaic activity and vc and cardiac propertits and map

Question 31

Heart affection during decompensation ?

Answer 31

cerebral ischemia causes inhibtion of the VMC and casuing inhibtion of the sympathtaic activity and vc and cardiac propertits and map Heart is affected due to decline in the properties due to less perfusion to heart and due to - vmc and due to myocardial depressant by pancreas due to its ischemia and this decrease the cop and map the Git and liver affected causing accumulation of toxin and ther role in depression of heart , venodilation and decrasing vr and cop and arterioldialtion and decraing tpr so map Kideny electrolyte disturbance casuing arrythmia and its role in 3 the other organs causing lactica acidosis and it has rule in heart depression and venulodilation and arterioldilation and decraeaing MAP

Question 32

Kideny in decompensation ?

Answer 32

Kideny electrolyte disturbance casuing arrythmia and its role in 3 - myocardial depression - venodilation - arteriodilation

Question 33

كيف كان طلبك للعلم يا ابن الجوزي ؟

Answer 33

ولقد كنتُ في حلاوة طلَبِ العلم أَلْقى من الشَّدائد ما هو أحلى عندي من العسَل في سبيل ما أطلبُ وأرجو فكيف كان صباك اذا؟ وكنتُ في زمن الصِّبا آخذُ معي أرغفةً يابسة، ثم أذهب به في طلب الحديث، وأقعد على نهر عيسى، ثُم آكل هذا الرَّغيف، وأشرب الماء، فكلَّما أكلتُ لقمةً شربتُ عليه ،

Question 34

Neprilysin inhibitors: Sacubitril explain !

Answer 34

Mechanism of action: • Inhibits endopeptidase Neprilysin → ↓ breakdown Natriuretic Peptides (NPs) & angiotensin II • ↑ NP → direct vasodilation, ↑ GFR → ↓release of renin from the kidney, Loss of H20 and sodium in urine (Natriuretic

Question 35

Sacubitril -valsartan combination (Angiotensin Receptor Neprilysin Inhibitor= ARNI) usage ?

Answer 35

used in place of ACEIs or | ARBS in patient with LVEF < 40%

Question 36

In case of decompensated shock hypercoasulability occur illustrate ?

Answer 36

In case of decompensated shock hypercoasulability occur illustrate ? This is due to ischemic toxins and and sluggish blood flow leads to coronary thromobosis and cardiac ischemia and MI Hypoxia Hyperthermia may pericptate thrombosis

Question 37

The irreversivle shock mean in detail ?

Answer 37

it is refractory shock h this intermideate shock last for hours and has no response to treatment by pressor agent and cop remains decreaesd even if the Blood volume back normal This is due to VASOCOSTRICTION excessive by sympathatics and catecholamines leading to? Decrease blood flow into the capillaries casuign tissue hypoxia and releasing deleterious substances TNF and lactic acid and this leads to relaxation of the precapillary sphincter allows flowing of blood to the damaged blood in capillaries and mixed with it and leading to capillarty fluid shift to ISF LEADING TO HYPOVOLEMIA but still the postcapillary sphincter is closed and this leads to stagnation of blood and forimng clots and rouleax formation after some time the postcapillary venules opens allowing spoiled blood with its rubbish to reach the lung casuing pulmonary embolism and damage to endothleim of alveolar capillarries and alveoli itslef and acute pulmonary distress syndrome no sufuctant

Question 38

Deleterious substances released by hypoxia tissue

Answer 38

SER LHTC Lactic acid Histamine tissue enzymes Serotonin Cytotkines TNF

Question 39

"لا نُزْهَةَ ألذُّ مِنَ النَّظَرِ فِي عُقُولِ الرِّجَالِ". | What are late organ failure due to shock ?

Answer 39

1-cerebral coronary remain despite the shock 2-The first organ Liver decrased metabolism and deteoxification 3-The kideny in burn crush injuries sepsis sever hge 4-the shock lung 5- intestinal complication 6-Reticuloendothelial system

Question 40

The kideny failure in shock occuri n ?

Answer 40

The kideny in burn crush injuries sepsis sever hge

Question 41

shock lung illustarate

Answer 41

this is due to arrival of spoiled blood from capillaries casuing pulmonary emolism and congestion and Damage to alveolar capillary endotheliem and and alvoli Decrease surfctant entering the ARDS

Question 42

intestinal complication IN ORGAIN FALURE DUE TO SHOCK ?

Answer 42

This is due to hypoxia casuing destruction of the tissue and arrival of the normal flora and its endotoxins into the blood due to the vc and imbalane between pre and post capillary sphincters !

Question 43

RES and shock ?

Answer 43

shock damage RES due to excessive VC leading to | loss of opsoniztion and phagocytic function of RES

Question 44

Cardiogenic shOCK leads to

Answer 44

Heart failure and cutanuous splanchmic skeleta vc casuing cold pain skin

Question 45

Low resistance shock is called

Answer 45

Warm shock no cold as in hypovoelmic

Question 46

مهم شوف الخريطتين الذهنيبتين اللي في الكتاب ص 398 ص400 حتى أنني أذكر في زمان الصبوة، ووقت الغلمة والعزبة قدرتي على أشياء كانت النفس تتوق إليها توقان العطشان إلى الماء الزلال، ولم يمنعني عنها إلا ما أثمر عندي العلم من خوف الله عز وجل. كيف نجوت من العجب ؟!

Answer 46

لولا خطايا لا يخلو منها البشر، لقد كنت أخاف على نفسي من العجب. غير أنه عز وجل صانني، وعلمني، وأطلعني من أسرار العلم معرفته، وإيثار الخلوة به، حتى أنه لو حضر معي معروف وبشر لرأيتها رحمة

Question 47

برمام prmam بر ماما ! advantages of ACEI OR ARBS

Answer 47

decrase preload and afterload Renoprotectiv in DM Mixed vasodilator withous reflex tachycardia or na water retention Alodsterone decrease Dec remodeling cardiac fibrosis hypokalemia arrythimia Decrese mortality rate!@@ with diurteic or BB

Question 48

The pros of ARBS Over ACEI ?

Answer 48

NO cough , no Bradykinin anatgonize ang2 whethe ACE OR NON ACE PATHWAY avoid hormonal escape phenomenos Increast AT2 activit VD and antiproliferative ! the cons lack of vasodilator effect of BK (PG & NO)

Question 49

عَنْ أَبي عَبْدِ الرَّحْمَنِ عَبْدِ اللَّهِ بنِ مَسْعُودٍ حَدَّثَنَا رَسُولُ اللَّهِ صَلَّى اللهُ عَلَيْهِ وَسَلَّمَ وَهُوَ الصَّادِقُ المَصْدُوقُ،"

Answer 49

قَالَ: "إِنَّ أَحَدَكُمْ يُجْمَعُ خَلْقُهُ فِي بَطْنِ أُمِّهِ أَرْبَعِينَ يَوْمًا نُطْفَةً، ثُمَّ يَكُونُ عَلَقَةً مِثْلَ ذَلِكَ، ثُمَّ يَكُونُ مُضْغَةً مِثْلَ ذَلِكَ، ثُمَّ يُرسَلُ إِلَيهِ الْمَلَكُ فَيَنْفَخُ فِيهِ الرُّوحُ وَيُؤْمَرُ بِأَرْبَعِ كَلِمَاتٍ: بِكَتْبِ رِزْقَهِ وَأَجَلِهِ وعَمَلِهِ، وَشَقِيٌّ أَوْ سَعِيدٌ، فَواللهِ الَّذي لا إِلَهَ غَيرُهُ إِنَّ أَحَدَكُمْ لَيَعْمَلُ بعملِ أهلِ الجَنَّةِ حَتَّى مَا يَكُونُ بَيْنَهُ وَبَيْنَها إِلَّا ذِرَاعٌ، فَيَسْبِقُ عَلَيْهِ الكِتَابُ، فَيَعْمَلُ بِعَمَلِ أَهْلِ النَّارِ فَيدخُلُهَا، وإنَّ أحدَكُم ليَعْمَلُ بعملِ أهلِ النَّارِ حَتَّى مَا يَكُونُ بَيْنَهُ وَبَيْنَها إِلَّا ذِرَاعٌ، فَيَسْبِقُ عَلَيْهِ الكِتَابُ، فَيَعْمَلُ بِعَمَلِ أَهْلِ الجَنَّةِ فيَدخلُها

Question 50

عن عمر بن الخطاب وابنه عبد الله وأبي هريرة -رضي الله عنهم- مرفوعاً: -».

Answer 50

«أُمِرْتُ أن أقاتل الناس حتى يشهدوا أن لا إله إلا الله وأن محمدًا رسول الله، ويُقيموا الصلاة، ويُؤتوا الزكاة، فإذا فعلوا ذلك عصموا مني دماءَهم وأموالَهم إلا بحق الإسلام وحسابُهم على الله -تعالي