shock test!!! Flashcards
the 3 other types of shock
cardiogenic shock
hypovolemic Shock
metabolism shock
in the simplified view of the cardiovascular system.. the heart
serves as the pump
function of the heart
pushes blood with a lot of force
what does the right side of the heart do
pushes blood to the lungs to acquire oxygen
what does the left side of the heart do
pushes blood through the aorta, then to all body tissues
cardiogenic shock
body tissues don’t receive blood because of a faukty heart
what is usually the culrint of cardiogenic shock
the left side of the heart
coronary arteries
blood vessels that deliver blood to cardiac muscle and help them generate energy
what does a blockage of the coronary artery do»_space;»>
failure of heart muscle (heart attack)
what does a heart attack lead to
to a failure of blood flow to other tissues, leading to shock
the five coronary arteries (rdlcl)
right coronary artery
distal right coronary artery
left main coronary artery
circumflex coronary artery
left anterior descending
coronary artery
what are the two types of heart attacks
ischemia, infarction
ischemia of heart muscle
partial blockage leads to a limited blood supply to the heart
in most cases of ischemia to the heart///////
the heart is still strong enough to keep a person alive and breathing
in ischemia the heart cannot work hard enough….
to beat fast when a person exercises
what happens when the heart exerts itself too hard
chest pain
chest pain
angina pectoris
infarction of heart muscle
comes for complete blockage and leads to a failure of heart muscle
infarction to the heart usually comes from
a blood clot that suddenly embeds itself in a coronary artery
because of their sudden nature, heart attack are termed
acute myocardial infarctions (AMIs)
AMIs will lead to…..
health problems and likely necrosis of heart muscle
what is the most important coronary artery
left anterior descending artery
what is the most important chamber of the heart
left ventricle»> pushes blood through aortic valve and into the rest of the body
widow maker
first 1-2 cm of the left anterior descending artery after it branches off the left main coronary artery
the human body should contain how much blood
5 litres
hypovolemic shock occurs when
the body drops significantly under 5 litres of blood
different reasons for hypovolemic shock
blood loss
plasma loss
fluid loss
blood loss in relation to hypovolemic shock
injury to the body causes blood to exit the body or spill into body cavities
plasma loss in relation to hypovolemic shock
burns to the skin causes the loss of plasma
fluid loss in relation to hypovolemic shock
dehydration, diarrhea, vomiting or sodium causes a loss of water from the bloodstream
in all cases of hypovolemic shock
the condition gets more extreme as more fluid is lost
of how much of the blood results in death in hypovolemic shock
50% +
classification of hemorrhage: as blood is lost
heart rate increases, blood pressure slows down, the CNS becomes confused and declines
what is done to reverse hypovolemic shock
IV fluids, plasma transfusions, and/or blood transfusion to replace lost blood volume
IV fluids
saline, or slighly salty water
what can’t the administration. IV fluids, plasma trnasfusions, blood transfusions can’t be done too quickly
patients with hypovolemic shock, especially the elderly begin showing weakness in heart muscle
if too mcuh fluid is administered treating hypovolemic shoock
there would be a backup of fluid because the heart can’t pump it fast enough
a backup of fluid because the heart can’t pump it fast enough will lead to
cardiogenic pulmonary edema
metabolic shock is unique because
not a failure of oxygen delivery… but a failure of glucose delivery
to look closer at metabolic shock»>
must look a regulation of glucose delivery
sugars are digested and»_space;»
float through the body as glucose
cells have a chanel that allows glucose to enter
normally closed unless signaled by insulin
where in insulin made
in B-cells in the pancreas
when is insulin made and secreted
when glucose is detected in the blood stream
diabetes mellitus
disease characterized by a deficiency in insulin
type 1 diabetes is also knwon as
juevenile diabetes
type 1 diabetes
pancreas does not produce enough insulin for the body
type 2 diabetes is known as
adult onset diabetes
type 2 diabetes
body is desensitized to insulin»> result of obesity
why is type 2 diabetes usually the result of obesity
the body is too big or the pancreas is too weak to properly distribute insulin
what is gestational diabetes
a pregnant woman can’t produce enogh insulin for both herself and her unborn child> ends when pregnancy dies
what is the result of insufficient insulin
the body has poor regulation of its glucose levels
hyperglycemia in diabetics»>
too much sugar in the blood because it can’t blood
usually hyperglycemia leads to glucose being
taken in by the liver and stored in long chains of glycogen
in diabetes….. glucose in the blood
can’t enter liver cells and can’t be stored
what normally happens in hypoglycemia
body releases supplies of glycogen
in diabetes… glycogen in the liver
is never created
diabetic must eat several times a day or face
diabetic coma
without glucose to break down for enegry»»>
cells shift to the breakdown of lipids
lipids breakdown creates
toxic byproducts acetoacetic acid and acetone
acetoacetic acid and acetone are excreted through
the lungs and give off a fruity odor
if the body relys to much on lipid breakdown
too much acetoacetic acid» acidosis»> normal shock
excessive acidosis due to lipid breakdown
patients eventually fall unconscious»» diabetic coma
primary symptoms of diabetic coma
> > fruity breath
shocks of the airway
respiratory shock
anaphylactic shock
inhalation begins
with the nose, but can start with the mouth
after air being inhaled in the nose
in the nasal cavity.. air is warmed and moistened
what is after the nasal cavity
the pharynx
pharynx function
holds food and air
what is after the pharynx
epiglottis
epiglottis function
directs food down the esophagus and air down the larynx
what is after the epigottis»_space;> larynx
trachea
trachea is heavily coated in
in mucus and cilia and filters the air before it enters the lungs
at the entrance of the lungs….
the trachea splits into left and right bronchi
bronchi split into
smaller and smaller bronchioles»_space;> which then break into alveoli
bronchi can be categorized
based on how many branches have aready occured
at the base of the trachea there is …
division into left and right primary bronchi
the _____ bronchus is significantly bigger
right
all immediate divisions from the primary bronchi
secondary bronchi
how many secondary bronchi in the left lung
two
how many secondary bronchi in the right lung
three
which part of the lung has 3 lobes
right
branches from secondary bronchi
tertiary bronchi
branches after tertiary brinchi
4th order, 5th order etc….
when do bronchi become bronchioles…
no cartilage in the walls … only elastin
respiratory shock
failure of gas exchange in the lungs
respiratory shock is typically caused by
trauma to the lungs or airway
respiratory shock happens because
pleural effusion
atelectasis
pulmonary edema
pleural effusionn
pleural cavity has been compromised
atelectasis
air is not making it to the alveoli
pulmonary edema
alveoli are filled with fluid
each lung is surrounded by
two concentric sacs, together called the pleurae
more deep of sacs surrounding the lungs
visceral pleura
more superficial of sacs surrounding the lungs
parietal pleura
there should usually be what between pleurae and lungs
few millimeters of pleural fluid to lubricate (otherwise empty)
pneumothorax
air gets trapped in the pleural cavity
hemothorax
blood gets trapped in the pleural cavity
hemopneumothorax
Blood and air gets trapped in the pleural cavity
hydrothorax
water gets trapped in the pleural caviy
urinothorax
urine gets trapped in the pleural cavity
pyothorax
pus gets trapped in the pleural cavity
tension pneumothorax
special pneumothorax… pressure builds up in the pleura and pushes heart to the side… causing drop in blood pressure
pleural effusion
any of the things where there is fluid in the lungs
tension pneumothorax can be
immediately life-threatening… by causing other types of shock
pneumothorax.. hemothorax and hemopneumothorax are called
punctured lunsg
how to treat punctured lungs
inserting a chest tube
atelectasis is a blockage
of the lungs, preventing air from making to the alveoli
where does atelectasis usually happen
in bronchi or bronchioles
reason 1 for atelectasis
mucus plug blocks the airway
treatment for mucus plug blocking the airway
percussion on the chest
reason 2 for atelectasis
physical blockkages (i=kids inhaling toys)
treatment for physical blockages
bronchoscopy
reason 3 for atelectasis
tumor in the lungs
treatment for a tumor in the lungs
removal
note atelectases
not all are that bad
pulmonary edema is the buildup
buildup of fluid (most often blood ) in the lungs
why is pulmoary edema different from a pleural effusion
pleural effusion is a buildup of fluid around the lungs
two categories of pulmonary edema
cardiogenic
noncardiogenic
cardiogenic edema
caused by low-functioning heart
noncardiogeic edema
caused by variety of other factors
in both cardiogenic and noncardiogenic edema….
alveoli fill with fluid and cannot facilitate the exchange of oxygen and carbon dioxide
anaphylactic shock
deficiency in perfusion due to anaphylaxis
anaphylaxis
severe allergic reaction
people with allergies,…..
have immune systems that recognize mostly harmless substances, such as pollen, as danger
in an allergic reaction.. the body releases
histamine
histamine functions
as a neurotransmitter or hormone to activate many different responses in the body
example of receptor histamine binds to
periphery receptor; caused bronchoconstriction»can’t breathe>shock
histamine binds to
variety of receptors
symptoms of histamine binding to receptors
Hives Vomitting Diarrhea Light-Headedness Swelling of mouth / air way shortness of breath low blood pressure abnormally slow or fast heart rate
worst of histamine symptoms
swelling of the airway»> can’t inhale or exhale.» cant breathe» death
antihistamines
antagonists for histamine receptors
by blocking histamine receptors
block them from sending danger signals and inhibit stuff
antihistamines specifically target which receptors
H1 receptors
H1 receptors are found
in the peripheral NS and central NS
first-generation antihistamines
passed through blood brain barrier and blocked H1 receptors everywhere
H1 receptors in the CNS
wakefullness, appetite,
second-generation antihistamines
can no longer pass through the blood brain barrier because they are lipophobic
what particles are best at passing through the blood brain barrier
small, lipophilic, uncharged
antihistamines are usually….
small. uncharged, mostly lipophilic
distributive shock
failure of blood vessels to bring blood to the right place
circulatory system can be broken into …
the pump, the container, the stuff
distributive shock is a problem with
the container… it is too big
what types of shock are caused by distributive shock
anaphylactic shock
neurogenic shock
Psychogenic Shock
Septic Shock
Anaphylactic shock
deficiency in perfusion due to to anaphylaxis
another important function of periphery H1 receptors
vasodilation
H2 receptors are primarily
involved in vasodilation
second scariest of symptoms cause by histamine
low blood pressure …. if it drops too low… a patient is at risk for distributive shock (even though the respratory shock is fixed)
neurogenic and psychogenic shock come from
failure of the nervous system to control muscles that regulate blood vessels
three types of muscle tissues
skeletal
smooth
cardiac
skeletal muscle
can be voluntarily controlled and is found in and round important organs
smooth muscle
cannot be voluntarily controlled and is found in and around important organs
cardiac muscle
cannot be voluntarily controlled and is found only in the heart
smooth muscles are found….
in blood vessels and control vasoconstriction or vasodilation
vasodilation and vasoconstriction
crucial for blood pressure
too much dilation
blood pressure drops
too much contriction
blood pressure spikes
distributive shock is caused by
excessive vasodilation
how are smooth muscles controlled
not by CNS, by hormones
the sympathetic pathway of smooth muclses releases
epinephrine and norepinephrine
sympathetic pathway
- Also called the “fight or flight” response
- Causes many effects, including vasoconstriction across most blood vessels and an increase in heart rate
time sympathetic pathway
-Acts and dissipates in seconds
parasympathetic pathway releases
acetylcholine (ACh)
parasympathetic pathway
Also called the “feed or breed” response-Causes many effects, including vasodilation across most blood vessels and a decrease in heart rate-
parasympathetic pathway time
acts and dissipates in minutes – longer
signals for each the parasympathetic and sympathetic responses are carried from
the brain down the spinal cod to reach blood vessels i abdomen and legs
when the spinal cord is severed..
each system is wiped out and the body loses control of all smooth muscles
since the parasympathetic nervous system takes so long to dissipate
we see extreme vasodilation
failure of nervous system to regulate_____
failure to regulate blood pressure… neurogenic shock
vagus nerve
long nerve in the body responsible for stimulation of parasympathetic nervous system
vagus nerve is stimulated
by many things
….. each released ACh and causes vasoldilation and slowed heart rate
when the vagus nerve is triggered,,,,
vasovagal response
vasovagal response
-results in low blood pressure, short term deficiency of oxygen to the brain»> syncope
is the vasovagal response dead
almost always not
syncope
fainting
important chemical released in response to infection and help fight it
cytokines
too big infection
too many cytokines released»> bad stuff
usually cytokines are made to…
recruit white blood cells, which release more cytokines in a positive feedback loop
cytokine positive feedback loop is supposed
to stay localized and get shutoff at a certain point
in an infection gets too big…
the body does not shut down cytokines…. cytokine stor
result of cytokine storm
widespread inflammation
widespread inflammation from cytokine storm can lead to
ARDS» which can lead to death
ARDS
acute respiratory distress syndrome
cytokine storms can also lead to
severe damage to blood vessels when they dilate too much and for too long»>
svsere damage to blood vssels leads to
blood spilling int the extracellular space
blood spilling into the extracellular space causes
reddish slotches on the skin»_space; petechiae
blood spilling into extracellular space also leads to
decreased oxygen flow to cells» shock
shock
lack of oxygen flow to cells
if not treated… shock always leads to
cellular death
associated words shock
hypoxia hypoxemia ischemia infarction necrosis
hypoxia
not enough oxygen in an area
hypoxemia
not enough oxygen in the blood
ischemia
not enough blood flow to an area
infarction
complete blockage of blood flow to an area
necrosis
tissue death due to lack of blood flow
different cells can
survive for different lengths of time without oxygen
skin cells without oxygen
live days to weeks
muscle cells without oxygen
about 48 hours
the most fragile cell type (n terms of oxygen flow)
neurons in the brain
neurons without oxygen
irreversible damage after 10 minutes
patients who clinically die for 10 minutes
will always have impaired mental function if resuscitated
clinically dying
no breathing, no blood flow
why will you have impaired mental function if you don’t have oxygen for 10 minutes
- neurons need more ATP to maintain a delicate charge
- neurons can not allow lipids to enter
- neurons have no backup ATP stored in creatine phosphate
since neurons need ATP to maintain a delicate charge???
must aqquire this ATP through the breakdown of glucose
since neurons cannot allow lipids to enter»»»>
they cannot use those for fuel
BBB
Blood Brain Barrier
8 types of shock
-Respiratory Shock-
Anaphylactic Shock-
Neurogenic Shock-
Cardiogenic Shock-
Hypovolemic Shock-
Metabolic Shock-
Psychogenic Shock-
Septic Shock
why is shock bad
because all cells need oxygen supply
deficiency of oxygen is called
hypoxia
all cells need energy in the form of
ATP (adenosine triphosphate)
two ways for cells to get energy
Aerobic Respiration
Anaerobic Respiration
Aerobic Respiration breaks down and produces
- breaks down glucose
- produce 36 ATP molecules
aerobic respiration uses what and makes what byproducst
uses oxygen
non toxic byproducts: CO2 and H2O
anaerobic glycolysis breaks down and produces
- breaks down glucose
- produces 2 ATP per molecule
anaerobic glycolysis uses what and makes what byproduct
- doe NOT use oxygen
- produces the toxic byproduct lactic acid
as lactic acid build up in cells
it begins to exit them through passive transport and enters the bloodstream instead
lactate and lactic acid
are very similar ad can flip flop back and forth in equilibrium
equilibrium point where lactate and lactic acid can flip flop
pH=4
at physiological pH levels, almost all lactic acid in the body
has dissociated into lactate and H+
so if there is lactic acid that has dissociated into lactate and H+……..
at normal body temperatures…. extra H+ is released
a liquid’s acidity comes from
the concentration of H+ ions, more H+= more acidic
so the H+ that comes form lactic acid
H+ from lactic acid mixes with the blood and lowers its pH
condition where blood pH is too low
below 7.35
where blood pH is too low…..
acidosis
acidosis what happens to neurons
the resting potential of neurons is even lower than normal
what happens when the resting potential of neurons is lower than normal
requires more excitatory signal to cause a nerve to fire
if resting potential gets too low
nerves fire far too little»»» coma
in alkalosis what happens to neurons
the resting potential of neurons is higher than normal
when the resting potential of neurons is higher than normal
only a little excitation is necessary before a nerve fires
if resting potential gets too high
nerves fire too much»» seizure
what is something very essential to cellular survival
the sodium/potassium pump
how does the sodium potassium pump work
against a concentration gradient and uses ATP
what does the sodium/potassium pump move
3 sodium ions out of the cell while pumping two potassium ions in
When the Na+/K+ pump fails……
cells build up extremely high levels of sodium inside
when there is very high levels of sodium in cells
water rushes into cells from the environment through the principles of osmosis
when water rushes into cells as a result of high sodium level…..
the cells swell to large sizes and grow increasingly unstable
what are lysosomes
large bag of enzymes that serve as molecular scissors
enzymes in lysosomes…
can cut almost all molecules
what happens to lysosomes in reponse to decreased ATP supplies
lysosomes break apart and release enzymes to the cell
usually lysosomal enzymes»>
are denatured at normal pH , only work at acidic pH levels
when the cell’s pH is lower»_space; from lack of oxygen»> lysosomal enzymes
can work when they escape and destroy the cell
lysosome-mediated apoptosis is usually
a normal event in cells
why is lysosome-mediated apoptosis bad in the case of shock
because a cell’s membrane ceases to function correctly
why would a cell membrane not function correctly in lysosome-mediated apoptosis in the case of shock
- the cell is too big and its membrane is spread thin
- the internal/external concentration gradients are wrong
as a result of apoptosis during shock…..
leakage of cellular debris and lysosomal enzymes
leakage of cellular debris and lysosomal enzymes as a result of apoptosis during shock will….
spread to nearby tissues through blood and leads to more cell death»»»leads to tissue death
step 1 shock
Cells rely too much on anaerobic respiration for energy and build up large supplies of lactic acid
step 2 shock
Lactic acid enters the bloodstream
step 3 shock
Lactic acid dissociates
step 4 shock
Hydrogen ions lower pH of blood (acidosis)-
step 5 shock
Na+/K+ pumps fail to work in cell membranes
step 6 shock
Lysosomes release their enzymes
step 7 shock
Cells die and release debris into the bloodstream
step 8 shock
The debris spreads and damages more and more tissue until death.
