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CVS Physiology > Shock > Flashcards

Shock Flashcards

1
Q

ولقد كنتُ في حلاوة طلَبِ العلم أَلْقى من الشَّدائد ما هو أحلى عندي من العسَل في سبيل ما أطلبُ وأرجو، وكنتُ في زمن الصِّبا آخذُ معي أرغفةً يابسة، ثم أذهب به في طلب الحديث، وأقعد على نهر عيسى، ثُم آكل هذا الرَّغيف، وأشرب الماء، فكلَّما أكلتُ لقمةً شربتُ عليها
إن الله كتب الإحسان علي كل شئ

Give defintion to Circulatory SHOCK .

A

It isdecreased perfusion to the tissue and the blood oxygen and nutrients epscailly the vital organan like brain hindring tissue from doing theri metabolic functions

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2
Q

Types of SHOCK ?

نمت وأدلج الناس !

A

Hypovolemic cold shock
Low resistance shock decrased TPR ( Vasogenic ,distributive shock)
Cardiogenic shock
other shocks

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3
Q

The ABP is not a measuer for tissue perfusion why?

A

this is becasue decreasing in abp casue reflex vasoconstriviton casuing decreasing blood perfusion of tissue woeseining shock

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4
Q

Explain hypovolemic shock .

A

It is shocke due to decrease in blood volume due to
1-Hemorrhage
2-Vomitting and diarrhea
3-burns
this decreases MCP and VR and COP DECRASING ABP
The compensatory mechanism by/??\
vc of splanchnic git and skeletal vessels
عشان يوفر الدم للقلب والدماغ !
causing cold pain skin

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5
Q

Cardiogenic shock definition

A

A shock resulted from weakness of the pump function of the hear despite good VR and filling but the COP is reduced like in massive myocardial infarction
the compensatory mechanism is VC of cutanuous blood vessel leaving cold pale skin

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6
Q

Low resistance shock mean ?

A 
it is a shock not due to blood volume or pump prboelms but becasue VD of peripheral vasculture casuing decreasing TPR and incrasing vascular capacitness anddecrasing mean circulatory pressure
calle warm shock caues the extremities are not cold as hypovolemic shock
both MCP AN TPR 
MEANT VR AND COP AND MAP 
'
its casuses are diveded into 
1-neurogenic 
2-anaphylactic
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7
Q

Deep general anethesia and shock ?>

A

it casuses depression of the VMC neurogenic shock low resistence

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8
Q

spinal shock explain.

A

shocke due to loss of sympathatic tone due spinal anethesia or spinal cord lesion blocking the sympathatic out flow to vessels and the vc tone decreasing TPR and MCP and COP ABP
POTENT CAUSE OF NEUROGENICS

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9
Q

Brain damage can cause shock ?

A

yes in case of brain damage contusion or concussion to the basal are there is ischemia and stimulation of VMC incresing ABP 5-7minutes if prolonged this leads to inactivation of VMC tpr and cop and abp casuing neurogenic shock

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10
Q

Define/generalized vasodilation

A

a case caused by the symphatatic cholinergic fibers of hypothalamus and this leads to genral VD decreasing TPR ABP NEUROGENIC SHOC K

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11
Q

Mention neurogenic shock

A

-deep general anethesia
-spinal shock
-brain damage
-generalized VD
GBS DEEP

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12
Q

Discuss Anaphylactic shock as atype of low resistance shock

A

When a person is sensitized to antigen and reexpoed to it this leads to
degranulation of Mast cells and Basophils releasing histamine VD substances
causing arterilodilation and capillary shift fluid casuing hypovolemia

the hypotension may be severe casuing circulatory collapse
incompitable blood transfusion

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13
Q

How does septic shock take the characatetstics of other 3 types of shock ?

A

Septic shock is in case of sepsis = septicemia the bacatrail infection + its endotoxins running in blood casuing fever and increased tissue demands from o2 and nutrient
it is like :بيضرب مساحة الوعاء والقلب كذلك
1-low resistance shock becasue toxins casue generalized VD decrasigng TPR and VR and causing decreased ABP and low perfusion يقلل سرعة وصول الدم للانسجة
يزود الدم للانسجة الميتة والتعبانة ويقلله للانسجة السليمة
Hypotension is due decrased both MCP and TPR Dure to vasodilation on veins and arteries
2-hypovolemic shock : the vasodilation of arteriole increases pressure in capillaries casuing fluid shif into ISF
3-Cardiogenic shock : toxins casue cardiac depression

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14
Q

Explain traumatic shock ?

A

Occur when there is sever damadge to tissue like bonea and muscles in wars or accidents causing
internal bleeding or external hemorrahge :hypovolemic shock
the severe pain casues neurogenic shock

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15
Q

combination of shocks in Surgical shock mention

A

surgical shock in case of surgical operation causing
hypovolemic shock : internal bleeding +external hemorrhage
low resistance shock neurogenic: due to severe pain
dehydration

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16
Q

Stages of shock mention

A

-Non progrssive compensated no tratment spontanupusly
progressive decompensated treatment aid
Refractory there is no use , treatment no recovery

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17
Q

Cardiogenc and low resistance shock cannot be compensated GR.

A

becasuse compensatory depednds on heart and vascular respones

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17
Q

Cardiogenc and low resistance shock cannot be compensated GR.

A

becasuse compensatory depednds on heart and vascular respones

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18
Q

GR/ Hypovolemic shock can be compensated ?

A

this is due to no problems in the heart or vessels

and the compensatory mechansimsd epednds on heart and vascular respones

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19
Q

Define non progressive shock ?

A

it is compensated ! where the circulatory compensatory mechanisms can work to return the normal state of circulation wihtout aid from the out side by
incraseing ABP immediate Onset
Increasing BV delayed onset

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19
Q

Define non progressive shock ?

A

it is compensated ! where the circulatory compensatory mechanisms can work to return the normal state of circulation wihtout aid from the out side by
incraseing ABP immediate Onset
Increasing BV delayed onset

20
Q

Define progressive shock ?>

A

Decompensated in which

the the shock without outside treatment will lead to worsen of the state till death

21
Q

The irrversible shock?

A

Refractory shock which even if you give the patient treatment is is no use and he will die even in the moment the patient is still alive

22
Q

Discuss decompensatory mechanisms .

A 
There is decrased in MAP 
and this leads to inteses sympatahtic activity and its vasoconstriction but ! 
still the Organ blood flow is low ?  
this affect vital organs as follow:
 The Heart > Myocardial failure 
the Git and Liver > 
1-Mycoardial depressant >Myocardial failure 
2-accumulation of toxins 
The kidney
Electorlyte imbalance 
the other organs 
acidosis VD mechanisms

A-the affect on heart dierctly and by the myocardial depressant from pancreas casuser myocardial failure decreasing COP AND MAP
B-the effect of
accumulation of toxin
Electorlyte imbalance especially hyperkalemia >arryhtmia
acidosis VD mechanisms
periciptate :
1-Myocardial failure > dec cop > MAP
2-decrasinG Venous tone and MCP and VR and COP
3- DECRASING Artriolar tone decraesing the TPR AND MAP
AND CAPILLARY FILTRATION DECREASING VR and cop

23
Q

إن من أول ما أدرك الناس من النبوة الأولي إن لم تستح فاصنع ما شئت

A

-الحديث يمكن ان يشير الي معنيين
الاول : انه ان لم يكن عند الانسان الحياء فانه يفعل ما يشاء سواء كان مخزيا او ليس من المرؤة او كان منها
الثاني: هو انه اذا كان ماتفعل فعل لا يستحيي منه فافعله ولا تبالي

-الحديث فيه دليل علي بقاء اثار الامم السابقة ومن سبق من الانبياء
الحياء شعبة من شعب الايمان
منه حياء لله وحياء للعباد
الحياء من الله هو ان يراك حيث امرك وان يفقدك حيث نهاك
الحياء من العباد هو فعل ماهو من المروءة

فمثلا لو كنت في الصف الاول وممدت قدميك فهذا ليس من المروء ولكن لوكنت في وسط اصحابك فهذا ليس فيه حياء

24
Q

عن ابي عمرة سفيان بن عبدالله رضي الله عنه قال قلت لرسول الله “يارسول الله قلي لي في الاسلام قولا لا اسال عنه احدا غيرك قال :قل آمنت بالله ثم استقم “

A

هاتان الكلمتان جمعا الدين كله
امنت بالله فيه القول باللسان والقلب
استقم فيه العمل بالجوارح

وهذا يشمل اساس الدين الاخلاص والمتابعة !

25
Q

إن الحلال بين وإن الحرام بين وبينهما أمور متشابهات من لايعلمهن كثير من الناس فمن اتقي الشبهات فقد استبرئ لدينه وعرضه ومن وقع في الشبهات وقع في الحرام كالراعي يرعي حول الحمي يوشك ان يقع فيه الا و ان لكل ملك حمي ألا وإن حمي الله محارمه إلا وإن في الجسد مضغة اذا صلحت صلح الجسد كله واذا فسدت فسد الجسد كله ألا وهي القلب

A 
يوشك ان يقع فيه 
لان راعي البقر لو رعي حول حمي مخضرة فتوشك البهائم ان تدخل ذاك الحمي ومن الصعب ان تخرجها 
كذلك الانسان الطواف حول المتشابهات فانه يوشك ان يقع في الحرام وصعب ان يخرج منه 
اسباب المتشابهات 
قلة العلم 
قلة الفهم 
التقصير في التدبر 
سوء القصد والتعصب ! 
هذا الاشتباه لايكون علي جميع الناس
26
Q

adveres effects of ARBS ?

A 
Well Tolerated than ACEI 
Hanuta
Hyperkalemia
anigoedma 
unsafe to fetus 
taste disturbance 
aucte renal failure in case or renal hypo perfuysiom
27
Q

Non progressive shock in detail

A

It is the hypovolemic shock and it is compensated by the mechanisms succeeding in reutrining cop to normal value and recovery and this is by ?

Short term and long mechanisms in restoring ABP
nhiniton of Baroreceptors impulses due to hypotension sensation !
Stimulation of chemoreceptors
stimulatrion of CNS ischemic respone
all cause stimulaiton
of VMC casuing increasr VC of peripheral
and increasing cardiac propertirs
-angionteni2 and Vasopressin due to renal hypoperfusion renin !
Renal and hormonal

Short term and long compensatory mechanisms in restoring blood volume
Capillary fluid shift
and
Labile tissue and liver proteins to plasma increasing osmolarity and absorption from ISF
AND
Contraction of splenic capsule

1- thrist ang2 and hormonal water conservation
2- plasma proteins replaced by liver
3-RBCS replaced by Bone marrow

28
Q

Progressive decomensated shock in detail ?

A

This is when compenstaion fails decompensation begins!
cerebral ischemia causes inhibtion of the VMC and casuing inhibtion of the sympathtaic activity and vc and cardiac propertits and map
Heart is affected due to decline in the properties due to less perfusion to heart and due to - vmc and due to myocardial depressant by pancreas due to its ischemia and this decrease the cop and map
the Git and liver affected causing accumulation of toxin and ther role in depression of heart , venodilation and decrasing vr and cop and arterioldialtion and decraing tpr so map
Kideny electrolyte disturbance casuing arrythmia and its role in 3
the other organs causing lactica acidosis and it has rule in heart depression and venulodilation and arterioldilation and decraeaing MAP

In case of decompensated shock hypercoasulability occur illustrate ?
This is due to ischemic toxins and and sluggish blood flow
leads to coronary thromobosis and cardiac ischemia and MI
Hypoxia
Hyperthermia may pericptate thrombosis

29
Q

Artrioldilation mechanism in decompensation

A

it casued by the \
cerberal ischemia decrasing the VMC and Sympathatic activit

accumulation of toxin of liver

kideny electrolye disturbance

organs lactica acidosis

results in ! 2?
1- dec TPR and MAP
2-iNCREASING CAPILLARY SHIFT FLUID DECRASING VOLUME AND CARDIAC OUTPUT

30
Q

Cerebral ischemia as decompensation mechanism ?

A

cerebral ischemia causes inhibtion of the VMC and casuing inhibtion of the sympathtaic activity and vc and cardiac propertits and map

31
Q

Heart affection during decompensation ?

A

cerebral ischemia causes inhibtion of the VMC and casuing inhibtion of the sympathtaic activity and vc and cardiac propertits and map
Heart is affected due to decline in the properties due to less perfusion to heart and due to - vmc and due to myocardial depressant by pancreas due to its ischemia and this decrease the cop and map
the Git and liver affected causing accumulation of toxin and ther role in depression of heart , venodilation and decrasing vr and cop and arterioldialtion and decraing tpr so map
Kideny electrolyte disturbance casuing arrythmia and its role in 3
the other organs causing lactica acidosis and it has rule in heart depression and venulodilation and arterioldilation and decraeaing MAP

32
Q

Kideny in decompensation ?

A

Kideny electrolyte disturbance casuing arrythmia and its role in 3

  • myocardial depression
  • venodilation
  • arteriodilation
33
Q

كيف كان طلبك للعلم يا ابن الجوزي ؟

A

ولقد كنتُ في حلاوة طلَبِ العلم أَلْقى من الشَّدائد ما هو أحلى عندي من العسَل في سبيل ما أطلبُ وأرجو
فكيف كان صباك اذا؟

وكنتُ في زمن الصِّبا آخذُ معي أرغفةً يابسة، ثم أذهب به في طلب الحديث، وأقعد على نهر عيسى، ثُم آكل هذا الرَّغيف، وأشرب الماء، فكلَّما أكلتُ لقمةً شربتُ عليه

،

34
Q

Neprilysin inhibitors: Sacubitril explain !

A

Mechanism of action:
• Inhibits endopeptidase Neprilysin → ↓ breakdown Natriuretic Peptides (NPs) & angiotensin II
• ↑ NP → direct vasodilation, ↑ GFR → ↓release of renin from the kidney, Loss of H20 and sodium in urine (Natriuretic

35
Q

Sacubitril -valsartan combination (Angiotensin Receptor Neprilysin Inhibitor= ARNI)
usage ?

A

used in place of ACEIs or

ARBS in patient with LVEF < 40%

36
Q

In case of decompensated shock hypercoasulability occur illustrate ?

A

In case of decompensated shock hypercoasulability occur illustrate ?
This is due to ischemic toxins and and sluggish blood flow
leads to coronary thromobosis and cardiac ischemia and MI
Hypoxia
Hyperthermia may pericptate thrombosis

37
Q

The irreversivle shock mean in detail ?

A

it is refractory shock h this intermideate shock last for hours and has no response to treatment by pressor agent and cop remains decreaesd even if the Blood volume back normal

This is due to VASOCOSTRICTION excessive by sympathatics and catecholamines leading to? Decrease blood flow into the capillaries casuign tissue hypoxia and releasing deleterious substances TNF and lactic acid and this leads to relaxation of the precapillary sphincter allows flowing of blood to the damaged blood in capillaries and mixed with it and leading to capillarty fluid shift to ISF LEADING TO HYPOVOLEMIA but still the postcapillary sphincter is closed and this leads to stagnation of blood and forimng clots and rouleax formation after some time the postcapillary venules opens allowing spoiled blood with its rubbish to reach the lung casuing pulmonary embolism and damage to endothleim of alveolar capillarries and alveoli itslef and acute pulmonary distress syndrome no sufuctant

38
Q

Deleterious substances released by hypoxia tissue

A

SER LHTC

Lactic acid
Histamine
tissue enzymes

Serotonin
Cytotkines TNF

39
Q

“لا نُزْهَةَ ألذُّ مِنَ النَّظَرِ فِي عُقُولِ الرِّجَالِ”.

What are late organ failure due to shock ?

A

1-cerebral coronary remain despite the shock
2-The first organ Liver decrased metabolism and deteoxification
3-The kideny in burn crush injuries sepsis sever hge
4-the shock lung
5- intestinal complication
6-Reticuloendothelial system

40
Q

The kideny failure in shock occuri n ?

A

The kideny in burn crush injuries sepsis sever hge

41
Q

shock lung illustarate

A

this is due to arrival of spoiled blood from capillaries
casuing pulmonary emolism and congestion and
Damage to alveolar capillary endotheliem and and alvoli
Decrease surfctant entering the ARDS

42
Q

intestinal complication IN ORGAIN FALURE DUE TO SHOCK ?

A

This is due to hypoxia casuing destruction of the tissue and arrival of the normal flora and its endotoxins into the blood

due to the vc and imbalane between pre and post capillary sphincters !

43
Q

RES and shock ?

A

shock damage RES due to excessive VC leading to

loss of opsoniztion and phagocytic function of RES

44
Q

Cardiogenic shOCK leads to

A

Heart failure and cutanuous splanchmic skeleta vc casuing cold pain skin

45
Q

Low resistance shock is called

A

Warm shock no cold as in hypovoelmic

46
Q

مهم شوف الخريطتين الذهنيبتين اللي في الكتاب ص 398
ص400
حتى أنني أذكر في زمان الصبوة، ووقت الغلمة والعزبة قدرتي على أشياء كانت النفس تتوق إليها توقان العطشان إلى الماء الزلال، ولم يمنعني عنها إلا ما أثمر عندي العلم من خوف الله عز وجل.
كيف نجوت من العجب ؟!

A

لولا خطايا لا يخلو منها البشر، لقد كنت أخاف على نفسي من العجب.
غير أنه عز وجل صانني، وعلمني، وأطلعني من أسرار العلم معرفته، وإيثار الخلوة به، حتى أنه لو حضر معي معروف وبشر لرأيتها رحمة

47
Q

برمام
prmam
بر ماما !
advantages of ACEI OR ARBS

A

decrase preload and afterload
Renoprotectiv in DM
Mixed vasodilator withous reflex tachycardia or na water retention
Alodsterone decrease Dec remodeling cardiac fibrosis hypokalemia arrythimia
Decrese mortality rate!@@ with diurteic or BB

48
Q

The pros of ARBS Over ACEI ?

A

NO cough , no Bradykinin
anatgonize ang2 whethe ACE OR NON ACE PATHWAY
avoid hormonal escape phenomenos
Increast AT2 activit VD and antiproliferative !
the cons
lack of vasodilator effect of BK (PG & NO)

49
Q

عَنْ أَبي عَبْدِ الرَّحْمَنِ عَبْدِ اللَّهِ بنِ مَسْعُودٍ حَدَّثَنَا رَسُولُ اللَّهِ صَلَّى اللهُ عَلَيْهِ وَسَلَّمَ وَهُوَ الصَّادِقُ المَصْدُوقُ،”

A

قَالَ: “إِنَّ أَحَدَكُمْ يُجْمَعُ خَلْقُهُ فِي بَطْنِ أُمِّهِ أَرْبَعِينَ يَوْمًا نُطْفَةً، ثُمَّ يَكُونُ عَلَقَةً مِثْلَ ذَلِكَ، ثُمَّ يَكُونُ مُضْغَةً مِثْلَ ذَلِكَ، ثُمَّ يُرسَلُ إِلَيهِ الْمَلَكُ فَيَنْفَخُ فِيهِ الرُّوحُ وَيُؤْمَرُ بِأَرْبَعِ كَلِمَاتٍ: بِكَتْبِ رِزْقَهِ وَأَجَلِهِ وعَمَلِهِ، وَشَقِيٌّ أَوْ سَعِيدٌ، فَواللهِ الَّذي لا إِلَهَ غَيرُهُ إِنَّ أَحَدَكُمْ لَيَعْمَلُ بعملِ أهلِ الجَنَّةِ حَتَّى مَا يَكُونُ بَيْنَهُ وَبَيْنَها إِلَّا ذِرَاعٌ، فَيَسْبِقُ عَلَيْهِ الكِتَابُ، فَيَعْمَلُ بِعَمَلِ أَهْلِ النَّارِ فَيدخُلُهَا، وإنَّ أحدَكُم ليَعْمَلُ بعملِ أهلِ النَّارِ حَتَّى مَا يَكُونُ بَيْنَهُ وَبَيْنَها إِلَّا ذِرَاعٌ، فَيَسْبِقُ عَلَيْهِ الكِتَابُ، فَيَعْمَلُ بِعَمَلِ أَهْلِ الجَنَّةِ فيَدخلُها

50
Q

عن عمر بن الخطاب وابنه عبد الله وأبي هريرة -رضي الله عنهم- مرفوعاً: -».

A

«أُمِرْتُ أن أقاتل الناس حتى يشهدوا أن لا إله إلا الله وأن محمدًا رسول الله، ويُقيموا الصلاة، ويُؤتوا الزكاة، فإذا فعلوا ذلك عصموا مني دماءَهم وأموالَهم إلا بحق الإسلام وحسابُهم على الله -تعالي

CVS Physiology (14 decks)

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