Shock Flashcards
What are the Types of Shock?
- Distributive Shock
- Septic Shock
- Anaphylactic Shock
- Neurogenic Shock
- Hypovolemic Shock
- Cardiogenic Shock
- Obstructive Shock
Distributive Shock.
A.K.A vasodilatory shock
It is inadequate perfusion to the tissue!
The blood vessels dilate resulting in loss of vessel tone and ultimately systemic vasodilation. LEading to decreased blood flow to the organs.
What are the Three Types of Distributive Shock?
- Septic
- Anaphylactic
- Neurogenic
Septic Shock.
Caused by a pathogenic infection present in the blood or injury. This leads to a severe drop in blood pressure resulting in systemic vasodilation.
Anaphylactic Shock.
Caused by a severe allergic reaction causing the body to go into shock. Anaphylaxis causes the immune system to release a flood of immune mediators that can result in a sudden drop in BP and narrow the airways.
Neurogenic Shock.
Caused by a spinal cord injury or damage to the nervous system. The heart rate, blood pressure and temperature are subsequently unstable due to the damage.
What Occurs During Distributive Shock? (Three steps)
Step One: Inflammation is caused by a pathogen, allergen or injury.
Step Two: The inflammation leads to an overwhelming release of immune mediators that cause an overpowering response.
Step Three: In response, the vessels will vasodilate causing low perfusion volume and yields a fluid shift (due to capillary leakage)
What are the Three Stages of Inflammation?
- Vascular Response
- Cellular Stage
- Remodelling and Maturation
Vascular Response.
An allergen introduced within the system triggers inflammation. The purpose of vascular changes is to increase blood flow to the local area, venous and arteriole vasodilation will cause increased capillary flow.
What is the Role of Histamine?
When an allergen attaches to a mast cell it releases histamine. The role of histamine is to bind to H1 receptors on the endothelial cells and stimulate vasodilation.
Role of Nitric Oxide.
Nitric Oxide is released as well as histamine. Nitric Oxide is released and contributes to vasodilation.
How Does The Body React To Histamine?
- Swelling and Inflammation
- Adrenaline Release
- Bronchoconstriction
- Dilation of the blood vessels
- Increased Heart Rate
- Increased vessel and capillary permeability
- Stimulation of gastric acid secretion
- Blood Clotting
Signs and Symptoms of Reaction.
Heat to extremities, redness, swelling, pain, difficulty breathing, tachycardia
Cellular Stage.
In this stage, phagocytes are released and travel to the site of inflammation. White blood cells are increased in production and kill the pathogens responsible for inflammation.
Mechanism of Action For Phagocytosis.
- The pathogen/antigen binds to the receptor of the phagocyte
- The phagocyte engulfs the pathogen through endocytosis. Once inside the cell, the phagosome fuses with lysosomes
- The phagolysosome is now able to kill and digest other microbes
Remodelling and Maturation.
At this stage, the tissues start to repair. As healing progresses, the tissue continues to remodel, strengthen and improve its cellular organization.
How to Treat Inflammation.
- Antihistamines
- Leukotriene Modifiers
- Glucocorticoids
- Xolair
How do Antihistamines Treat Inflammation?
Histamine antagonists.
- Therefore, inhibiting the inflammatory response!
How do Leukotriene Modifiers Treat Inflammation?
Leukotrine anatagonists.
- Medications that block the effect of leukotrienes or stop your body from producing them. By inhibiting Leukocytes (white blood cells), therefore inhibiting the release of; neutrophils, basophils, lymphocytes, and monocytes
How do Glucocorticoids Treat Inflammation?
Inhibits immune response.
- Glucocorticoids regulate adaptive immunity by inhibiting lymphocyte activation and promoting lymphocyte apoptosis. At high concentrations, glucocorticoids also inhibit the production of B cells and T cells.
How does Xolair (Omalizumab) function?
Reduces IgE.
- Immunoglobulin E are antibodies produced by the immune system. They are attached to mast cells and signal a reaction when an antigen binds to the receptor site. By reducing IgE, the reaction is reduced.
Acute Progressive Allergic Reaction.
Allergy- Anaphylaxis- Anaphylactic Shock
Treatment for Acute Progressive Allergic Reaction.
- Adrenergics: adrenaline will increase BP and increase perfusion
- Epinephrine IM every 5 minutes, 3 doses max
- Antihistamines: Benadryl (Diphenhydramine) via IV
- Glucocorticoids: Hydrocortisone and Methypredsione via IV
- Support airway, breathing and circulation
Circulatory Shock.
Hypoperfusion to organs and tissue leads to an insufficient supply of nutrients and oxygen to meet the body’s demands. Therefore putting the body into shock.
Remember: hypoxia causes altered cellular function and overall cellular necrosis due to a lack of nutrients and required needs.
