Chapter 7: Fluid and Hemodynamic Disorders Flashcards
dilation of arterioles
-blushing, exercise, inflammation
active hyperemia
decrease of venous flow; often associated with ______
passive hyperemia (congestion) hydrostatic edema
the liver in patients with ______ results in a characteristic of ‘Nutmeg Liver’ (______)
chronic passive hyperemia of liver
right ventricular failure
multiple red depressed cells
the lung in the patients with left ventricular failure often leads to ______ (brown induration of the lung). The macrophages in the lung are known as ______
chronic passive hyperemia of lung
alveolar fibrosis
heart failure cells
pulsating flow
bright red color
arterial hemorrhage
steady, slow flow
dark red color
venous hemorrhage
slow, even flow
bright red color
capillary hemorrhage
- results from soft tissue injury
- accounts for nearly 10 million emergency department visits in the US each year
- can carry significant risks of patient ______ and ______
- the seriousness of the injury is dependent on ______ of the hemorrhage (arterial, venous, capillary) and the amount of ______ that can be tolerated by the patient
external hemorrhage morbidity disfigurement anatomical source blood loss
- can result from blunt or penetrating trauma, and acute or chronic medical illness
- internal bleeding that can cause ______ usually occurs in one of four body cavities: (list the 4 cavities)
internal hemorrhage hemodynamic instability chest abdomen pelvis peritoneum
respiratory tract bleeding
hemoptysis
vomiting blood
hematemesis
blood in urine
hematuria
uterovaginal bleeding
metrorrhagia
blood in stool or feces
indication of a GI bleed
melena
clot formation
thrombi
obstruction of the blood supply to an organ or tissue region (typically a thrombus) causes local death of the tissue
infarction
- white (______) infarct
- red(______) infarct
- the fate of infarcts depend on their ______, the type of cells forming in the ______, ______ of the organism, extent of ______
pale hemorrhagic anatomic site tissue circulatory status necrosis
Shock is:
INADEQUATE TISSUE PERFUSION
Stages of shock cellular level: Stage 1: Stage 2: Stage 3: Stage 4:
vasoconstriction
capillary and venule opening
disseminated intravascular coagulation
multiple organ failure
if this stage of shock is not treated by prompt restoration of ______, shock progresses to the next stage
stage 1
circulatory volume
- occurs with a 15%-25% decrease in ______ blood volume
- ______ rate, ______ rate, and ______ refill are increased. Blood pressure may still be normal
- Postcapillary sphincters resist local effects and remain closed, causing blood to pool or stagnate in the ______, producing ______
- as increasing ______ and ______ lead to opening of additional venules and capillaries, the vascular space expands greatly
Stage 2: Capillary and venule opening intravascular heart respiratory capillary capillary system capillary dilation hypoxia acidosis
Stage 2 continued:
- sluggish blood flow and the reduced delivery of oxygen result in increased ______ and the production of ______
- the ______ attempts to compensate for the acidosis by increasing ventilation to blow off ______
- as acidosis increases, and pH falls, the RBCs may cluster together (______)
- this stage of shock often progresses to the third stage if ______ is inadequate or delayed, or if the shock state is complicated by ______ or ______
anaerobic metabolism lactic acid respiratory system carbon dioxide rouleaux formation fluid resuscitation trauma sepsis
- time of onset will depend on degree of shock, patient age, and pre-existing medical conditions
- this stage occurs within 25%-35% decrease in ______ volume. At this stage, ______ occurs. This type of shock usually requires ______.
- This state is ______ to treatment (refractory shock), but is still ______
- distal tissue cells use ______ and lactic acid production ______
stage 3: disseminated intravascular coagulation (DIC) intravascular blood hypotension blood replacement resistant reversible anaerobic metabolism increases
- the amount of cellular necrosis required to produce organ failure varies with each organ and the underlying condition of the organ
- usually, ______ failure occurs, followed by ______ failure, and then ______ failure
- if ______ persists for more than 1 to 2 hours, the cells nourished by that capillary undergo changes that rapidly become irreversible.
- in this stage, ______ falls dramatically (to levels of 60 mmHg or less)
- cells can no longer use ______, and ______ stops.
Stage 4: multiple organ failure hepatic renal heart capillary occlusion blood pressure oxygen metabolism
- earliest stage
- body can still compensate for blood loss
- level of responsiveness is best indicator of tissue perfusion. Blood pressure is maintained
- treatment will typically result in recovery
compensated phase of shock
- blood pressure is falling
- blood volume drops by more than 30%
- compensatory measures begin to fail
- signs and symptoms are more obvious
- cardiac output falls dramatically
- treatment will sometimes result in recovery
decompensated phase of shock
- systemic inflammatory response syndrome (SIRS) is a generalized manifestation of a local immune or inflammatory reaction, which is often fatal. SIRS is a hyper metabolic state that features 2 or more signs of systemic inflammation such as fever, tachycardia, tachypnea, leukocytosis
- septic shock is defined as clinical SIRS so severe that it results in organ dysfunction and hypotension
- anti-inflammatory factors also play an important role in some patients. The result is compensated anti-infammatory response syndrome (CARS) , in which paralysis of the immune system resulting in a poor outcome
- Mortality of SIRS/MODS exceeds 50%, making it responsible for most deaths in non coronary intensive care units in the US
irreversible phase of shock
generalized manifestation of a local immune or inflammatory reaction, which is often fatal. it is a hyper metabolic state that features 2 or more signs of systemic inflammation such as fever, tachycardia, tachypnea, leukocytosis
systemic inflammatory response syndrome (SIRS)
defined as clinical SIRS so severe that it results in organ dysfunction and hypotension
septic shock
Heart fails in shock due to these conditions:
- myocardial heart failure
- ______ blood volume
- ______ vasodilation
- ______ vascular permeability
decrease
increase
increase
single most important factor in thrombosis is ______
- injury to endothelial cells can also alter local blood flow and affect ______
- abnormal blood flow (stasis or turbulence) in turn, can cause ______ injury
- the factors may act independently or may combine to cause thrombus formation
endothelial integrity
coagulability
endothelial
