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Trauma and Trauma Systems > physiology of life and death > Flashcards

physiology of life and death Flashcards

1
Q

maintenance of life

A
  • body systems are interrelated and interdependent
  • every cell and every organ work together to:
  • sustain cellular energy production
  • maintain vital metabolic processes
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2
Q

energy

A
  • energy powers all body functions
  • energy sustains cellular and organ functions
  • cells make energy from oxygen and glucose
  • energy is stored in the form of ATP (adenosine triphosphate molecules)
  • without energy, cellular functions cease
  • the goal is to help ensure that the patients body maintains energy production
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3
Q

ABC

A
  • airway- must be patent
  • breathing (lungs)
  • circulation
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4
Q

breathing

A
  • adequate oxygen must reach alveoli
  • cross alveolar/capillary wall and enter the circulation
  • CO2 is removed
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5
Q

circulation

A
  • distributes RBCs
  • ensures adequate number of RBCs
  • transports oxygen to every cell in every organ
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6
Q

airway

A

-an open airway is essential to deliver air (oxygen) to the alveoli

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7
Q

normal air movement

A
  • inhalation results from negative intrathoracic pressure as the chest expands (diaphragm contracts)
  • air fills the alveoli`
  • exhalation results from increase intrathoracic pressure as the chest relaxes (diaphragm relaxes)
  • forces air out of the alveoli
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8
Q

when air reaches the alveoli

A

-oxygen crosses the alveolar capillary membrane

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9
Q

oxygen

A
  • enters the RBCs

- attaches to hemoglobin for transport

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10
Q

CO2 in the plasma and cells

A
  • a by product of aerobic metabolism and energy production
  • crosses the alveolar capillary membrane into the alveoli
  • is removed during respiration
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11
Q

circulation

A
  • oxygen enriched RBCs are pumped through the blood vessels of the body to deliver oxygen to target organs
  • need a certain amount of blood and pumping heart for this
  • oxygen is then off loaded from the RBCs to fuel the metabolic processes of the cell
  • CO2 is transferred from the cells to the plasma for elimination via the lungs
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12
Q

aerobic metabolism

A
  • most efficient methods of energy production
  • uses oxygen and glucose to produce energy via chemical reactions known
  • produces large amounts of energy
  • waste products:
  • carbon dioxide
  • water
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13
Q

aerobic metabolism is dependent on

A
  • adequate and continuous supply of oxygen
  • patent airway
  • functioning lungs (pulmonary system)
  • functional heart- pump blood to the cells
  • intact vascular system
  • adequate supply of RBCs
  • carry and transport oxygen
  • remove waste
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14
Q

anaerobic metabolism

A
  • an injury that affects any of these three components of the oxygen delivery system will affect energy production
  • anaerobic metabolism is a metabolic process that functions in the absence of oxygen
  • metabolism WITHOUT adequate oxygen
  • uses stored glucose in the form of glycogen for energy production
  • capable of sustaining energy requirements only for a short time
  • produces only small amounts of energy
  • 19 fold decrease in energy
  • increased lactic acid as a by product
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15
Q

shock

A
  • inadequate energy production required to sustain life
  • change from aerobic to anaerobic metabolism
  • secondary to hypoperfusion
  • delivery of oxygen is inadequate to meet metabolic demands
  • decreased energy production
  • cellular and organ death
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16
Q

consequences of hypoperfusion

A
  • cellular hypoxia
  • decreased ATP (energy) production
  • cell dysfunction
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17
Q

cell dysfunction

A
  • lactic acid buildup
  • low pH
  • autodigestion of cells- leads to cellular death and organ failure
  • entry of sodium and water into the cell- cellular edema (swelling) worsens with overhydration
  • continuation of cycle- unless oxygenated RBCs reach the capillaries
  • if further loss of intravascular (blood) volume- the cycle continues
  • inadequate ATP
  • cells and organs do not function properly
  • hypothermia- decreased heat production
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18
Q

acidosis

A
  • what little ATP is being produced is used to shiver

- lactic acid production increases

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19
Q

coagulopathy

A

-as body temperature drops, blood clotting becomes impaired

20
Q

triangle of death

A
  • energy loss

- acidosis -> hypothermia -> coagulopathy

21
Q

cascade of death

A
  • anaerobic metabolism
  • decreased energy production
  • cellular death
  • organ death
  • patient death
22
Q

types of shock

A
  • shock is any condition that causes decreased cellular energy production
  • hypovolemic
  • distributive
  • cardiogenic
23
Q

hypovolemic shock

A
  • dehydration

- hemorrhage

24
Q

distributive shock

A
  • neurogenic
  • septic
  • anaphylactic
  • psychogenic
  • dilation -> edema
25
Q

cardiogenic shock

A

-pump failure (intrinsic vs extrinsic)

26
Q

hemorrhagic shock*

A
  • most common cause of hypoperfusion after trauma
  • internal or external blood loss
  • 4 classes of shock
  • can affect mental status
  • fluids are the treatment
  • respiratory rate increases
  • pulse increases
  • urine decreases (kidneys arnt getting circulation)
  • know the chart*
27
Q

neurogenic shock

A
  • associated with spinal cord injury
  • interruption of the sympathetic nervous system resulting in vasodilation
  • patient has normal blood volume but vascular container has enlarged, thus decreasing blood pressure
28
Q

cardiogenic shock: extrinsic

A
  • results from external compression of the heart
  • ventricles cannot fully expand
  • less blood is ejected with each contraction
  • blood return to the heart is decreased
  • causes from trauma include:
  • pericardial tamponade- blood collecting in pericardial sac-> restricts
  • tension pneumothorax- lung collapses and causes pressure restriction blood circulation
29
Q

pathophysiology of shock

A
  • shock is progressive
  • changes in shock include:
  • hemodynamic
  • cellular (metabolic)
  • microvascular
  • compensatory mechanisms are short term and will fail without interventions
  • heart must be an effective pump
  • primed by return of blood through the vena cavae -> starlings law
30
Q

stroke volume (SV)

A
  • amount of blood ejected with each contraction
  • depends on adequate return of blood
  • if blood volume decreases:
  • SV will decrease
  • cardiac output (CO) will decrease unless the heart rate (HR) increase
  • CO = SV x HR
31
Q

adequate blood pressure

A

-required to maintain cellular perfusion

32
Q

cardiac output (CO)

A
  • one factor in maintaining blood pressure (BP)
  • if CO falls:
  • vasoconstriction occurs
  • systemic vascular resistance (SVR) increases in an attempt to maintain BP
  • BP = CO x SVR
33
Q

vasocontriction

A
  • leads to the ischemic phase of shock

- veins constrict to focus on pumping to the heart but the other places will become ischemic eventually

34
Q

early microvascular changes

A
  • precapillary and postcapillary sphincters constrict
  • resulting in ischemia in the tissues
  • must then produce energy anaerobically
35
Q

as acidosis increases

A
  • the precapillary sphincters relax
  • the postcapillary sphincters remain constricted
  • this results in stagnation of blood in the capillary bed
36
Q

final microvascular changes

A
  • the post capillary sphincters relax
  • results in wash out
  • releases microemboli
  • aggravates acidosis
  • causes infarction of organs by microemboli
37
Q

signs associated with types of shock: hypovolemic**

A
  • cool clammy skin (bad circulation)
  • pale, cyanotic
  • BP drops
  • consciousness is altered
  • capillary refill is slow
38
Q

signs associated with types of shock: neurogenic

A
  • warm, dry skin temp
  • pink skin color
  • BP drops
  • lucid
  • normal capillary refill
  • (different from cardiogenic and hypovolemic)
39
Q

signs associated with types of shock: cardiogenic

A
  • cool, clammy skin temp
  • pale, cyanotic skin color
  • BP drops
  • consciousness is altered
  • capillary refill is slowed
40
Q

organ system failure due to shock

A
  • if not recognized and promptly corrected, shock will lead to organ dysfunction
  • first oxygen sensitive organs
  • then in other less oxygen sensitive organs
  • this cascading effect will lead to multi organ dysfunction syndrome and patient death
  • failure of one major organ system
  • mortality rate of approx 40%
  • as additional organ system fail, mortality approaches 100%
41
Q

organ sensitivity to hypoxia

A
  • extremely sensitive- brain, heart, lungs
  • moderately sensitive- kidneys, liver, gastrointestinal tract
  • least sensitive- muscle, bone, skin
42
Q

acute renal failure

A
  • may result if oxygen delivery is impaired for more than 45-60 mins
  • will result in:
  • decreased renal output
  • reduced clearing of toxic products
43
Q

acute respiratory distress syndrome (ARDS)

A
  • Results from:
  • Damage to the alveolar cells
  • Hyper-resuscitation (fluid overload)
  • Results in:
  • Leakage of fluid into the interstitial spaces and alveoli
44
Q

hemotologic failure

A

-Impaired clotting cascade
-May result from:
-Hypothermia
-Dilution of clotting factors from fluid
administration
-Depletion of clotting factors

45
Q

hepatic failure

A

-results from prolonged shock

46
Q

overwhelming infection

A

-results from decreased function of the immune system due to ischemia and loss of energy production

47
Q

summary

A

-Cellular function depends on adequate energy
production
-Adequate energy production depends on a continuous
and adequate supply of oxygen
-A continuous and adequate supply of
oxygen depends on:
• Patent airway
• Functioning lungs
• Functioning heart
•Intact circulation
-Interruption of the oxygen supply for any reason
will lead to anaerobic metabolism
-Anaerobic metabolism provides insufficient energy
to sustain cellular function for any length of time
-This leads to cellular dysfunction and cell death,
organ dysfunction and organ death, and ultimately
patient death
-Knowledge, understanding, and early recognition of impaired energy production
resulting from airway compromise, pulmonary
injury, and impaired circulation are key to early
recognition of shock.
-Prompt intervention by prehospital care providers to correct these conditions can
prevent the cascade of cellular dysfunction that
leads to organ death.
-This will improve the survival rate for victims of
traumatic injury.

Trauma and Trauma Systems (18 decks)

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