Shock Flashcards
Cardiogenic shock
decreased cardiac output due to pump failure
hypovolemic shock
decreased cardiac output due to loss of circulating voluume
anaphylactic shock
widespread vasodilation and increased vascular permeability form IgE hypersensitivity reaction
Neurological shock
neural control of vasomotor tone is lost resulting in generalized vasodilation
what is systemic inflammatory response syndrome (SIRS)
exaggerated and generalized manifestation of local inflammatory reaction, often fatel
(SIRS) massive inflammatory reaction is due to what
cytokines
how does one diagnose (SIRS)
two or more signs of systemic inflammation (fever, tachycardia)
what is sepsis
is (SIRS) with a culture-proven infection or obvious infection
what is septic shock
clinical sepsis severe enough to lead to organ dysfunction and hypotension
name 2 things that trigger a septic shock
- gram postive bacterial infections
2. gram negative bacterial and fungal
Septic shock: inflammatory mediators: toll-like receptors
on leukocytes, recognize microbial elements
Septic shock: inflammatory mediators: TNF, IL-1, gamma, 12 and 18
create pro-inflammatory state
Septic shock: inflammatory mediators: prostaglandins and PAF
activate endothelial cells, causing adhesion molecule synthesis and PRO-COAGULANT state
Septic shock: inflammatory mediators: complement cascade
activated by microbial components contributes to the hyperinflammatory state
septic shock: what are 3 major consequences for endothelial cell activation and injury
- thrombosis
- increased vascular permeability
- vasodilation
thrombosis: inflammatory mediators stimulate what
tissue factor and PAI-1 production
thorbosis decreases what
tissue factor pathway inhibitor, thormbomodulin and protein C
increased vascular permeability causes what
“3rd spacing” and edema which increases interstital fluid pressure which impedes blood flow into tissues= tissue hypofusion and stasis
what causes vasodilation
Increased NO synthesis and vasoactive inflammatory mediators
what does vasodilation lead to
hypo-tension and tissue hypo per fusion
Septic shock: name 2 broad metabolic abnormalities
hyperglycemia and insulin-resistance
cytokines, stress hormones and catecholamines rise what metabolic abnormality
gluconeogensis
pro-inflammatory cytokines give what metabolic abnormality
suppress insulin release and promote insulin resistance
hyper inflammatory state can activate what in the immune system
counter-regulatory immunosuppressive mechanisms, not sure if its helpful or hurtful
