4.-Fisiopato shock Flashcards
estado final de todos los shock?
desbalance entre demanda y aporte de O2 resultando en falla multiorganica
porque cambio la clasificacion?
para estandarizar su manejo
cuales son las 4 categorias?
hipovolemico
distributivo
cardiogenico
obstructivo
con que sistema se relaciona shock hipovolemico?
con la sangre
con que sistema se relaciona distributivo?
con el sistema vascular
con que sistema se relaciona obstructivo?
con el sistema circulatorio
cual es la defincion del shock hipovolemico?
inadecuada perfusion de organos causada por perdida de volumen intravascular
en que resulta la perdida de volumen en el shock hipovolemico?
caida de precarga, y reduccion de macro y microhemodinamia con consecuencias para el metabolismo del tejido y desencadena reacion inflamatoria
causas de shock hemorragico
acute
bleeding from an isolated injury to a large blood vessel,
gastrointestinal bleeding, nontraumatic vascular
rupture (e.g., aortic aneurysm), obstetric hemorrhage
(e.g., uterine atony), and hemorrhage in the region of
the ear, nose, and throat (vascular erosion).
ejemplo de shock hemorragico traumatico
politrauma
importancia de lesion de tejido blando?
The soft tissue injury
leads to postacute inflammation, . At the microcirculatory level, leukocyte–
endothelium interactions (5) and destruction of
endothelial membrane-
cause microvascular dysfunction
with capillary leak syndrome.
At the intracellular
level a metabolic imbalance arises (6) with possible
mitochondrial damage (7) and a negative influence on
the vasomotor system (8).
causas de shock hipovoemico?
It can be caused by hyperthermia,
persistent vomiting and diarrhea (e.g., cholera),
or uncompensated renal losses (e.g., diabetes insipidus,
hyperosmolar diabetic coma). Sequestration of
large quantities of fluid in the abdomen, e.g., in ileus
or liver cirrhosis, also leads to a reduction of
circulating plasma volume
causas de shock hipovolemico traumatico?
traumatic hypovolemic shock are
large surface burns, chemical burns, and deep skin
lesions.
importancia del trauma en shock hipovolemico?
activates the coagulation
cascade and the immune system, potentiating the
impairment of the macro- and microcirculation. The
inflammatory reaction results in damage to the endothelium,
increases capillary leak syndrome, and
causes severe coagulopathy
manejo de shock hipovolemico
reanimacion con fluidos controlar sangrado intubar traslado a centor de trauma qx de control de daños pam por metas
si embarazada sangrando?
tranexamico 1 a 2 gr
si sangrado por herida de bala o arma blanca o aneurisma roto?
hipotension permisiva (PAS 70 a 80)
si pcte quemado?
usar formula de brooks
definicion de shock distributivo?
a state of relative hypovolemia resulting
from pathological redistribution of the absolute
intravascular volume and is the most frequent form of
shock
causas de shock distributivo?
either a loss of regulation
of vascular tone, with volume being shifted within the
vascular system, and/or disordered permeability of the
vascular system with shifting of intravascular volume
into the interstitium.
definicion de shock sepotico?
a dysregulated response by the body to an infection
resulting in life-threatening organ dysfunctions.
fisiopato del shock septico?
endothelial
dysfunction, which leads to dysregulation of vascular
tone resulting in vasodilation, impaired distribution,
and volume shifting in the macro- and microcirculation,
and to a rise in vascular permeability
caracteristicas de shock toxico
is characterized by fever, severe hypotension,
and skin rash as the main symptoms. It is usually
triggered by toxins from certain staphylococci. The
incidencia y mortalidad de shock toxico
incidence is 0.5 / 100 000, and mortality is between
2% and 11%
caracteristicas de shock anafilactico?
is characterized by massive
histamine-mediated vasodilation and maldistribution
with a shift of fluid from the intravascular to the
extravascular space.
patogenesis de shock anafilactico?
acute systemic reaction usually
mediated by IgE-dependent hypersensitivity reactions.
central role is played by mast cells and the
histamine they release
incidencia y mortalidad anafilaxia?
anaphylactic reactions is 50 per 100 000 / year
Lifetime prevalence is reported at 0.5% to 2% and
mortality at 2% to 20%.
trigger de anafilaxia mas comun en niños?
comida
trigger mas comun en adultos?
picadura de insecto
definicion shock neurogenico?
a state of imbalance between
sympathetic and parasympathetic regulation of cardiac
action and vascular smooth muscle
mecanismo fisiopatologicos shock neurogenico?
Direct injury to the centers for circulatory regulation
due to compression (brainstem trauma),
ischemia (e.g., basilar artery thrombosis), or the
influence of drugs
● Altered afferents to the circulatory center in the
medulla oblongata due to fear, stress, or pain or
dysregulated vagal reflexes
—Interruption of the descending connection from the
bulbar regulatory centers to the spinal cord,
especially in patients who have sustained trauma
above the middle of the thoracic spine (paraplegia).
% de lesiones de ME que hacen shock neurogenico
15-20%
causas de shock neurogenico?
cerebral ischemia,
subarachnoid hemorrhage, meningitis, or, more
rarely, during or after epileptic seizures, rapid onset of
Guillain–Barré syndrome, pandysautonomia, or
cerebral herniatio
mortalidad shock neurogenico
20%
