Shock and Edema - 29 (Svesson)

Question 1

1. What are the three key elements of shock?

Answer 1

Shock is circulatory failure that results in inadequate oxygenation of the body tissue and it is a life-threatening condition

Question 2

2. Septic shock

Answer 2

Causes: sepsis, anaphylaxis, neurogenic
Signs: low blood pressure, high heart rate, altered mental state, clammy skin, oliguria (production of less urine), elevated blood lactate
You will notice normal cardiac chambers and preserved contractility (this is because the heart is not causing the shock)

Question 3

3. Identify the component of gram-negative bacteria that mediates septic shock.

Answer 3

In gram-negative bacteria they have an LPS protein that is responsible for stimulating a variety of mediators that depending on the number of LPS present can increase or decrease the effects of septic shock

Question 4

4. Describe the role of adrenomedullin in modulating vascular function.

Answer 4

In the intravascular space it can bind to receptors on the endothelial cell and this binding causes the tight junctions to pull even tighter together this then reduces the movement of solute out of the vascular space. When it enters the interstitial compartment it can induce vascular smooth muscle relaxation and thus result in vasodilation which will worsen septic shock

Question 5

5. Define the term edema.

Answer 5

Edema is an accumulation of fluid in interstitial space of body tissues.

Question 6

6. State the primary drivers of the movement of fluid into and out of vascular space.

Answer 6

Hydrostatic and colloid osmotic pressure serve as the two main forces of fluid movement into and out of vascular space. Hydrostatic pressure drives fluid out of vascular space, while colloid osmotic pressure draws fluid back into vascular space. An imbalance between these two causes a net flow of fluid into interstitial space, giving rise to edema

Question 7

7. Describe the mechanisms and common clinical causes of edema.

Answer 7

Increased capillary permeability, increased capillary hydrostatic pressure, decreased capillary oncotic pressure, and lymphatic obstruction

Question 8

Hypovolemic shock

Answer 8

Internal or external fluid loss leading to organ failure
Causes: Hemorrhage, severe burns, severe vomiting, diarrhea
Signs: same signs as a septic shock but in hypovolemic shock, we will see a reduced cardiac output
you will see small cardiac chambers and normal or high contractility

Question 9

cardiogenic shock

Answer 9

low cardiac output and inadequate oxygen transport.
Causes: Myocardial infarct, ventricular arrhythmia, cardiac myopathy, and valvular disease
Signs: High central venous pressure, low cardiac output
large ventricles and poor contractility

Question 10

obstructive shock

Answer 10

blockage in blood flow (can be in the heart or outside of the heart)
Causes: cardiac tamponade, pulmonary embolism, and pneumothorax
Signs: low cardiac output, high central venous pressure, same beginning signs as septic shock