Hemodynamic Disorders V Flashcards
infarction
death of tissue due to interruption in blood supply
time until cellular death due to hypoxia of neuron
3-4 minutes
time until cellular death of due to hypoxia of myocardium
20-30 minutes
time until cellular death of fibroblast due to hypoxia
hours
what is the typical shape of infartion
wedge-shaped
When do you get a red (hemorrhagic) infart
venous occlusion
loose tissues
tissues w/dual circulation
tissues previously congested due to sluggish flow
re-established blood flow to a site of previous arterial occlusion and necrosis
white (anemic) infart
typically of arterial occlusion in solid organs with limitation of blood flow into areas of ischemic necrosis
what is the dominant histologic characteristic of infarction
ischemic coagulative necrosis
how can you tell that an MI is several days old based on histology
dense polymorphonuclear leukocytic inflammatory infilitrate
when do you get a septic infarct
when the origin of an embolus is infected tissue
what is the major source of septic emboli
vegetations formed by bacteria growing on heart valves in bacterial endocarditis
shock
inadequate blood flow secondary to decreased CO or maldistributed output that results in irreversible tissue damage
sequela of shock
hypotension
impaired tissue perfusion
cellular hypoxia
examples of things that can cause cardiogenic shock
infarction
arrythmia
tamponade
pulmonary embolism
examples of things that can cause hypvolemic sshock
hemorrhage
fluid loss
burns
trauma
examples of things that can cause septic shock
septicemia
systemic microbial infection
endotoxic shock
neurogenic shock
neuogenic dysfunction causes loss of vascular tone and peripheral pooling of blood
anaphylatic shock
generalized IgE mediated type I hypersentiviy reaction
etiological classification
Septic Spinal Hypovolemic Hemorrhagiv Obstructive Cardiogenic Cellular toxin Anaphylactic Endocrine
the 5 unifying features of shock
intracellular calcium overload intracellular hydrogen ion cellular and interstitial edema catabolic metabolism inflammation
how many of the criteria do you need for shock in rosen’s empiric critiria
4 out of 6
what is rosen’s empriic critia
ill apparence HR >100 RR >22 acidic deceased urine output hypotension
nonpregressive stage of shock
reflex compensation
mechanisms maintain tissue perfusion
progressive stage of shock
worsening circulatory/metabolic imbalance
acidosis
irreversible stage of shock
irreversible tissue damage
what is cardiogenic shock
decreased CO and evidence of tissue hypoxia
criteria for cardiogenic shock
hypotension
30 mmHG below baseline
deceased cardiac output/SA
increased PCWP
how do you treat hemorrhagic shock
crystalloid bolus
blood transfusion prn
identify/treat cause
advantages to colloids
less fluid required
more volume in vascular space
potential to draw fluid in from tissues
disadvantages to colloids
expensive
allergic reactions
coagulopathies
what cytokines are you going to see from first to last
LPS
TNF
IL-1
IL6/8
sepsis
systemic inflammtory response syndrome + documented infection
severe sepsis
sepsis + multi organ dysfunction
septic shock
sepsis + hypotension refractory to volume resuscitation
spinal shock
initial loss of spinal cord function following spinal cord injury
why do you get hypotension due to neurogenic shock
loss of sympathetic tone, thus vasodilation and decreased SVR
only occurs with lesions at or above T6
why do you get bradycardia due to neurogenic shock
unopposed parasympathetic tone to heart
when do yo usee neurogenic shock with bradycardia
lesions at or above T4
