shock test!!! Flashcards
(253 cards)
1
Q
the 3 other types of shock
A
cardiogenic shock
hypovolemic Shock
metabolism shock
2
Q
in the simplified view of the cardiovascular system.. the heart
A
serves as the pump
3
Q
function of the heart
A
pushes blood with a lot of force
4
Q
what does the right side of the heart do
A
pushes blood to the lungs to acquire oxygen
5
Q
what does the left side of the heart do
A
pushes blood through the aorta, then to all body tissues
6
Q
cardiogenic shock
A
body tissues don’t receive blood because of a faukty heart
7
Q
what is usually the culrint of cardiogenic shock
A
the left side of the heart
8
Q
coronary arteries
A
blood vessels that deliver blood to cardiac muscle and help them generate energy
9
Q
what does a blockage of the coronary artery do»_space;»>
A
failure of heart muscle (heart attack)
10
Q
what does a heart attack lead to
A
to a failure of blood flow to other tissues, leading to shock
11
Q
the five coronary arteries (rdlcl)
A
right coronary artery
distal right coronary artery
left main coronary artery
circumflex coronary artery
left anterior descending
coronary artery
12
Q
what are the two types of heart attacks
A
ischemia, infarction
13
Q
ischemia of heart muscle
A
partial blockage leads to a limited blood supply to the heart
14
Q
in most cases of ischemia to the heart///////
A
the heart is still strong enough to keep a person alive and breathing
15
Q
in ischemia the heart cannot work hard enough….
A
to beat fast when a person exercises
16
Q
what happens when the heart exerts itself too hard
A
chest pain
17
Q
chest pain
A
angina pectoris
18
Q
infarction of heart muscle
A
comes for complete blockage and leads to a failure of heart muscle
19
Q
infarction to the heart usually comes from
A
a blood clot that suddenly embeds itself in a coronary artery
20
Q
because of their sudden nature, heart attack are termed
A
acute myocardial infarctions (AMIs)
21
Q
AMIs will lead to…..
A
health problems and likely necrosis of heart muscle
22
Q
what is the most important coronary artery
A
left anterior descending artery
23
Q
what is the most important chamber of the heart
A
left ventricle»> pushes blood through aortic valve and into the rest of the body
24
Q
widow maker
A
first 1-2 cm of the left anterior descending artery after it branches off the left main coronary artery
25
the human body should contain how much blood
5 litres
26
hypovolemic shock occurs when
the body drops significantly under 5 litres of blood
27
different reasons for hypovolemic shock
blood loss
plasma loss
fluid loss
28
blood loss in relation to hypovolemic shock
injury to the body causes blood to exit the body or spill into body cavities
29
plasma loss in relation to hypovolemic shock
burns to the skin causes the loss of plasma
30
fluid loss in relation to hypovolemic shock
dehydration, diarrhea, vomiting or sodium causes a loss of water from the bloodstream
31
in all cases of hypovolemic shock
the condition gets more extreme as more fluid is lost
32
of how much of the blood results in death in hypovolemic shock
50% +
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classification of hemorrhage: as blood is lost
heart rate increases, blood pressure slows down, the CNS becomes confused and declines
34
what is done to reverse hypovolemic shock
IV fluids, plasma transfusions, and/or blood transfusion to replace lost blood volume
35
IV fluids
saline, or slighly salty water
36
what can't the administration. IV fluids, plasma trnasfusions, blood transfusions can't be done too quickly
patients with hypovolemic shock, especially the elderly begin showing weakness in heart muscle
37
if too mcuh fluid is administered treating hypovolemic shoock
there would be a backup of fluid because the heart can't pump it fast enough
38
a backup of fluid because the heart can’t pump it fast enough will lead to
cardiogenic pulmonary edema
39
metabolic shock is unique because
not a failure of oxygen delivery... but a failure of glucose delivery
40
to look closer at metabolic shock>>>
must look a regulation of glucose delivery
41
sugars are digested and >>>>
float through the body as glucose
42
cells have a chanel that allows glucose to enter
normally closed unless signaled by insulin
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where in insulin made
in B-cells in the pancreas
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when is insulin made and secreted
when glucose is detected in the blood stream
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diabetes mellitus
disease characterized by a deficiency in insulin
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type 1 diabetes is also knwon as
juevenile diabetes
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type 1 diabetes
pancreas does not produce enough insulin for the body
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type 2 diabetes is known as
adult onset diabetes
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type 2 diabetes
body is desensitized to insulin>>> result of obesity
50
why is type 2 diabetes usually the result of obesity
the body is too big or the pancreas is too weak to properly distribute insulin
51
what is gestational diabetes
a pregnant woman can't produce enogh insulin for both herself and her unborn child> ends when pregnancy dies
52
what is the result of insufficient insulin
the body has poor regulation of its glucose levels
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hyperglycemia in diabetics>>>
too much sugar in the blood because it can't blood
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usually hyperglycemia leads to glucose being
taken in by the liver and stored in long chains of glycogen
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in diabetes..... glucose in the blood
can't enter liver cells and can't be stored
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what normally happens in hypoglycemia
body releases supplies of glycogen
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in diabetes... glycogen in the liver
is never created
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diabetic must eat several times a day or face
diabetic coma
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without glucose to break down for enegry>>>>>
cells shift to the breakdown of lipids
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lipids breakdown creates
toxic byproducts acetoacetic acid and acetone
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acetoacetic acid and acetone are excreted through
the lungs and give off a fruity odor
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if the body relys to much on lipid breakdown
too much acetoacetic acid>> acidosis>>> normal shock
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excessive acidosis due to lipid breakdown
patients eventually fall unconscious>>>> diabetic coma
64
primary symptoms of diabetic coma
>>fruity breath
65
shocks of the airway
respiratory shock
| anaphylactic shock
66
inhalation begins
with the nose, but can start with the mouth
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after air being inhaled in the nose
in the nasal cavity.. air is warmed and moistened
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what is after the nasal cavity
the pharynx
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pharynx function
holds food and air
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what is after the pharynx
epiglottis
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epiglottis function
directs food down the esophagus and air down the larynx
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what is after the epigottis >>> larynx
trachea
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trachea is heavily coated in
in mucus and cilia and filters the air before it enters the lungs
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at the entrance of the lungs....
the trachea splits into left and right bronchi
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bronchi split into
smaller and smaller bronchioles >>> which then break into alveoli
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bronchi can be categorized
based on how many branches have aready occured
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at the base of the trachea there is ...
division into left and right primary bronchi
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the _____ bronchus is significantly bigger
right
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all immediate divisions from the primary bronchi
secondary bronchi
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how many secondary bronchi in the left lung
two
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how many secondary bronchi in the right lung
three
82
which part of the lung has 3 lobes
right
83
branches from secondary bronchi
tertiary bronchi
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branches after tertiary brinchi
4th order, 5th order etc....
85
when do bronchi become bronchioles...
no cartilage in the walls ... only elastin
86
respiratory shock
failure of gas exchange in the lungs
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respiratory shock is typically caused by
trauma to the lungs or airway
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respiratory shock happens because
pleural effusion
atelectasis
pulmonary edema
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pleural effusionn
pleural cavity has been compromised
90
atelectasis
air is not making it to the alveoli
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pulmonary edema
alveoli are filled with fluid
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each lung is surrounded by
two concentric sacs, together called the pleurae
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more deep of sacs surrounding the lungs
visceral pleura
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more superficial of sacs surrounding the lungs
parietal pleura
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there should usually be what between pleurae and lungs
few millimeters of pleural fluid to lubricate (otherwise empty)
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pneumothorax
air gets trapped in the pleural cavity
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hemothorax
blood gets trapped in the pleural cavity
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hemopneumothorax
Blood and air gets trapped in the pleural cavity
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hydrothorax
water gets trapped in the pleural caviy
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urinothorax
urine gets trapped in the pleural cavity
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pyothorax
pus gets trapped in the pleural cavity
102
tension pneumothorax
special pneumothorax... pressure builds up in the pleura and pushes heart to the side... causing drop in blood pressure
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pleural effusion
any of the things where there is fluid in the lungs
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tension pneumothorax can be
immediately life-threatening... by causing other types of shock
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pneumothorax.. hemothorax and hemopneumothorax are called
punctured lunsg
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how to treat punctured lungs
inserting a chest tube
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atelectasis is a blockage
of the lungs, preventing air from making to the alveoli
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where does atelectasis usually happen
in bronchi or bronchioles
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reason 1 for atelectasis
mucus plug blocks the airway
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treatment for mucus plug blocking the airway
percussion on the chest
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reason 2 for atelectasis
physical blockkages (i=kids inhaling toys)
112
treatment for physical blockages
bronchoscopy
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reason 3 for atelectasis
tumor in the lungs
114
treatment for a tumor in the lungs
removal
115
note atelectases
not all are that bad
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pulmonary edema is the buildup
buildup of fluid (most often blood ) in the lungs
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why is pulmoary edema different from a pleural effusion
pleural effusion is a buildup of fluid around the lungs
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two categories of pulmonary edema
cardiogenic
| noncardiogenic
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cardiogenic edema
caused by low-functioning heart
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noncardiogeic edema
caused by variety of other factors
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in both cardiogenic and noncardiogenic edema....
alveoli fill with fluid and cannot facilitate the exchange of oxygen and carbon dioxide
122
anaphylactic shock
deficiency in perfusion due to anaphylaxis
123
anaphylaxis
severe allergic reaction
124
people with allergies,.....
have immune systems that recognize mostly harmless substances, such as pollen, as danger
125
in an allergic reaction.. the body releases
histamine
126
histamine functions
as a neurotransmitter or hormone to activate many different responses in the body
127
example of receptor histamine binds to
periphery receptor; caused bronchoconstriction>>can't breathe>shock
128
histamine binds to
variety of receptors
129
symptoms of histamine binding to receptors
```
Hives
Vomitting
Diarrhea
Light-Headedness
Swelling of mouth / air way
shortness of breath
low blood pressure
abnormally slow or fast heart rate
```
130
worst of histamine symptoms
swelling of the airway>>> can't inhale or exhale.>> cant breathe>> death
131
antihistamines
antagonists for histamine receptors
132
by blocking histamine receptors
block them from sending danger signals and inhibit stuff
133
antihistamines specifically target which receptors
H1 receptors
134
H1 receptors are found
in the peripheral NS and central NS
135
first-generation antihistamines
passed through blood brain barrier and blocked H1 receptors everywhere
136
H1 receptors in the CNS
wakefullness, appetite,
137
second-generation antihistamines
can no longer pass through the blood brain barrier because they are lipophobic
138
what particles are best at passing through the blood brain barrier
small, lipophilic, uncharged
139
antihistamines are usually....
small. uncharged, mostly lipophilic
140
distributive shock
failure of blood vessels to bring blood to the right place
141
circulatory system can be broken into ...
the pump, the container, the stuff
142
distributive shock is a problem with
the container... it is too big
143
what types of shock are caused by distributive shock
anaphylactic shock
neurogenic shock
Psychogenic Shock
Septic Shock
144
Anaphylactic shock
deficiency in perfusion due to to anaphylaxis
145
another important function of periphery H1 receptors
vasodilation
146
H2 receptors are primarily
involved in vasodilation
147
second scariest of symptoms cause by histamine
low blood pressure .... if it drops too low... a patient is at risk for distributive shock (even though the respratory shock is fixed)
148
neurogenic and psychogenic shock come from
failure of the nervous system to control muscles that regulate blood vessels
149
three types of muscle tissues
skeletal
smooth
cardiac
150
skeletal muscle
can be voluntarily controlled and is found in and round important organs
151
smooth muscle
cannot be voluntarily controlled and is found in and around important organs
152
cardiac muscle
cannot be voluntarily controlled and is found only in the heart
153
smooth muscles are found....
in blood vessels and control vasoconstriction or vasodilation
154
vasodilation and vasoconstriction
crucial for blood pressure
155
too much dilation
blood pressure drops
156
too much contriction
blood pressure spikes
157
distributive shock is caused by
excessive vasodilation
158
how are smooth muscles controlled
not by CNS, by hormones
159
the sympathetic pathway of smooth muclses releases
epinephrine and norepinephrine
160
sympathetic pathway
- Also called the “fight or flight” response
| - Causes many effects, including vasoconstriction across most blood vessels and an increase in heart rate
161
time sympathetic pathway
-Acts and dissipates in seconds
162
parasympathetic pathway releases
acetylcholine (ACh)
163
parasympathetic pathway
Also called the “feed or breed” response-Causes many effects, including vasodilation across most blood vessels and a decrease in heart rate-
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parasympathetic pathway time
acts and dissipates in minutes -- longer
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signals for each the parasympathetic and sympathetic responses are carried from
the brain down the spinal cod to reach blood vessels i abdomen and legs
166
when the spinal cord is severed..
each system is wiped out and the body loses control of all smooth muscles
167
since the parasympathetic nervous system takes so long to dissipate
we see extreme vasodilation
168
failure of nervous system to regulate_____
failure to regulate blood pressure... neurogenic shock
169
vagus nerve
long nerve in the body responsible for stimulation of parasympathetic nervous system
170
vagus nerve is stimulated
by many things
| ..... each released ACh and causes vasoldilation and slowed heart rate
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when the vagus nerve is triggered,,,,
vasovagal response
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vasovagal response
-results in low blood pressure, short term deficiency of oxygen to the brain>>> syncope
173
is the vasovagal response dead
almost always not
174
syncope
fainting
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important chemical released in response to infection and help fight it
cytokines
176
too big infection
too many cytokines released>>> bad stuff
177
usually cytokines are made to...
recruit white blood cells, which release more cytokines in a positive feedback loop
178
cytokine positive feedback loop is supposed
to stay localized and get shutoff at a certain point
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in an infection gets too big...
the body does not shut down cytokines.... cytokine stor
180
result of cytokine storm
widespread inflammation
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widespread inflammation from cytokine storm can lead to
ARDS>> which can lead to death
182
ARDS
acute respiratory distress syndrome
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cytokine storms can also lead to
severe damage to blood vessels when they dilate too much and for too long>>>
184
svsere damage to blood vssels leads to
blood spilling int the extracellular space
185
blood spilling into the extracellular space causes
reddish slotches on the skin >> petechiae
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blood spilling into extracellular space also leads to
decreased oxygen flow to cells>> shock
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shock
lack of oxygen flow to cells
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if not treated... shock always leads to
cellular death
189
associated words shock
```
hypoxia
hypoxemia
ischemia
infarction
necrosis
```
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hypoxia
not enough oxygen in an area
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hypoxemia
not enough oxygen in the blood
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ischemia
not enough blood flow to an area
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infarction
complete blockage of blood flow to an area
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necrosis
tissue death due to lack of blood flow
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different cells can
survive for different lengths of time without oxygen
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skin cells without oxygen
live days to weeks
197
muscle cells without oxygen
about 48 hours
198
the most fragile cell type (n terms of oxygen flow)
neurons in the brain
199
neurons without oxygen
irreversible damage after 10 minutes
200
patients who clinically die for 10 minutes
will always have impaired mental function if resuscitated
201
clinically dying
no breathing, no blood flow
202
why will you have impaired mental function if you don't have oxygen for 10 minutes
- neurons need more ATP to maintain a delicate charge
- neurons can not allow lipids to enter
- neurons have no backup ATP stored in creatine phosphate
203
since neurons need ATP to maintain a delicate charge???
must aqquire this ATP through the breakdown of glucose
204
since neurons cannot allow lipids to enter>>>>>>>
they cannot use those for fuel
205
BBB
Blood Brain Barrier
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8 types of shock
-Respiratory Shock-
Anaphylactic Shock-
Neurogenic Shock-
Cardiogenic Shock-
Hypovolemic Shock-
Metabolic Shock-
Psychogenic Shock-
Septic Shock
207
why is shock bad
because all cells need oxygen supply
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deficiency of oxygen is called
hypoxia
209
all cells need energy in the form of
ATP (adenosine triphosphate)
210
two ways for cells to get energy
Aerobic Respiration
| Anaerobic Respiration
211
Aerobic Respiration breaks down and produces
- breaks down glucose
| - produce 36 ATP molecules
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aerobic respiration uses what and makes what byproducst
uses oxygen
| non toxic byproducts: CO2 and H2O
213
anaerobic glycolysis breaks down and produces
- breaks down glucose
| - produces 2 ATP per molecule
214
anaerobic glycolysis uses what and makes what byproduct
- doe NOT use oxygen
| - produces the toxic byproduct lactic acid
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as lactic acid build up in cells
it begins to exit them through passive transport and enters the bloodstream instead
216
lactate and lactic acid
are very similar ad can flip flop back and forth in equilibrium
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equilibrium point where lactate and lactic acid can flip flop
pH=4
218
at physiological pH levels, almost all lactic acid in the body
has dissociated into lactate and H+
219
so if there is lactic acid that has dissociated into lactate and H+........
at normal body temperatures.... extra H+ is released
220
a liquid's acidity comes from
the concentration of H+ ions, more H+= more acidic
221
so the H+ that comes form lactic acid
H+ from lactic acid mixes with the blood and lowers its pH
222
condition where blood pH is too low
below 7.35
223
where blood pH is too low.....
acidosis
224
acidosis what happens to neurons
the resting potential of neurons is even lower than normal
225
what happens when the resting potential of neurons is lower than normal
requires more excitatory signal to cause a nerve to fire
226
if resting potential gets too low
nerves fire far too little>>>>>> coma
227
in alkalosis what happens to neurons
the resting potential of neurons is higher than normal
228
when the resting potential of neurons is higher than normal
only a little excitation is necessary before a nerve fires
229
if resting potential gets too high
nerves fire too much>>>> seizure
230
what is something very essential to cellular survival
the sodium/potassium pump
231
how does the sodium potassium pump work
against a concentration gradient and uses ATP
232
what does the sodium/potassium pump move
3 sodium ions out of the cell while pumping two potassium ions in
233
When the Na+/K+ pump fails......
cells build up extremely high levels of sodium inside
234
when there is very high levels of sodium in cells
water rushes into cells from the environment through the principles of osmosis
235
when water rushes into cells as a result of high sodium level.....
the cells swell to large sizes and grow increasingly unstable
236
what are lysosomes
large bag of enzymes that serve as molecular scissors
237
enzymes in lysosomes...
can cut almost all molecules
238
what happens to lysosomes in reponse to decreased ATP supplies
lysosomes break apart and release enzymes to the cell
239
usually lysosomal enzymes>>>
are denatured at normal pH , only work at acidic pH levels
240
when the cell's pH is lower >> from lack of oxygen>>> lysosomal enzymes
can work when they escape and destroy the cell
241
lysosome-mediated apoptosis is usually
a normal event in cells
242
why is lysosome-mediated apoptosis bad in the case of shock
because a cell's membrane ceases to function correctly
243
why would a cell membrane not function correctly in lysosome-mediated apoptosis in the case of shock
- the cell is too big and its membrane is spread thin
| - the internal/external concentration gradients are wrong
244
as a result of apoptosis during shock.....
leakage of cellular debris and lysosomal enzymes
245
leakage of cellular debris and lysosomal enzymes as a result of apoptosis during shock will....
spread to nearby tissues through blood and leads to more cell death>>>>>>leads to tissue death
246
step 1 shock
Cells rely too much on anaerobic respiration for energy and build up large supplies of lactic acid
247
step 2 shock
Lactic acid enters the bloodstream
248
step 3 shock
Lactic acid dissociates
249
step 4 shock
Hydrogen ions lower pH of blood (acidosis)-
250
step 5 shock
Na+/K+ pumps fail to work in cell membranes
251
step 6 shock
Lysosomes release their enzymes
252
step 7 shock
Cells die and release debris into the bloodstream
253
step 8 shock
The debris spreads and damages more and more tissue until death.
