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14 Cards in this Set
- Front
- Back
Definition of Shock |
A state of inadequate oxygen delivery or oxygen extraction to/at the tissues |
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Signs and Symptoms of Shock |
Pallor - pale Cold Sweat weak/undetectable pulse loss of sensibility musclar collapse weakness of cardiac action |
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Brain vicious cycle |
Severe fall in BP > Low cerebral blood flow > iscemic brainstem depression > loss of sympathetic tone > cardiac depression + vasodilation > Fall in BP |
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Organ vicious cycle |
Inadequate blood flow > hypoxia > lactic acid > metabolic acidosis > cardiac depression > inadequate blood flow |
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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 |
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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 |
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How does sympathetic output effect insulin and glucagon release? |
Insulin: decreased Glucagon: increased |
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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 |
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What is the mechanism of the drop of hematocrit? |
Diluting intravascular space with fluid that is non blood. |
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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. |
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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 |
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What hormones can be administered through IV to patient with hemorrhage while restoring blood volume? |
Vasopressin Epinephrine Calcium chloride (need to keep up heart) |
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Cause of death after trauma: |
Earliest (chronologically): from bleeding (27%) CNS: 53% Latest onset: Organ failure (12%) |