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14 Cards in this Set

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Definition of Shock

A state of inadequate oxygen delivery or oxygen extraction to/at the tissues

Signs and Symptoms of Shock

Pallor - pale


Cold Sweat


weak/undetectable pulse


loss of sensibility


musclar collapse


weakness of cardiac action

Brain vicious cycle

Severe fall in BP > Low cerebral blood flow > iscemic brainstem depression > loss of sympathetic tone > cardiac depression + vasodilation > Fall in BP

Organ vicious cycle

Inadequate blood flow > hypoxia > lactic acid > metabolic acidosis > cardiac depression > inadequate blood flow

Net Effects of Hormonal Reponse

CV: Vascoconstriction & Cardiac contractility




Conserving: Antidiuresis & Sodium Retention




Metabolic: Catabolism leading to hyperglycemia


-provide glucose to brain and heart


-raise extracellular osmolality to draw fluid from ICF to ECF

What hormone gives rise to metabolic response to hemorrhage

Cortisol:


Increase AA by muscle catabolism and protein


Stimulate Gluconeogenesis and glycogenolysis in liver to release more glucose to blood


Block glucose from moving into tissue




Epinephrine:


Stimulate lipolysis in adipose tissue


Stimulate livers gluconeogen +glycogenolysis




Sympathetic output



How does sympathetic output effect insulin and glucagon release?

Insulin: decreased




Glucagon: increased

During hemorrhage, what happens to transcapillary fluid movement?

Arterial side: hydrostatic pressure lower, less blood moving to interstitial space




Venous side: Same % of protein, so same amount of water will come in from ISF to capillary. Hct drops because % of blood drops (more water)




Cells make more solute that move to ISF (hormonal/autonomic reponse), draws fluid from ICF to ECF.




Goal to increase CO by increasing fluid

What is the mechanism of the drop of hematocrit?

Diluting intravascular space with fluid that is non blood.

What happens to Plasma Protein concentration during transcapillary refill?

Will drop in the first few hours, then level off. Due to being diluted with mostly water.

Time course of compensation to hemorrhage:

Movement of water: a second


Reflex vasoconstriction: seconds


Hormonal response: minutes


-Increase vascular tone


-glucogenolysis


Lymphatic return of protein: hours


Synthesis of new protein: day

What hormones can be administered through IV to patient with hemorrhage while restoring blood volume?

Vasopressin


Epinephrine


Calcium chloride (need to keep up heart)

Cause of death after trauma:

Earliest (chronologically): from bleeding (27%)




CNS: 53%




Latest onset: Organ failure (12%)