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pathophysiology > shock test!!! > Flashcards

shock test!!! Flashcards

1
Q

the 3 other types of shock

A

cardiogenic shock
hypovolemic Shock
metabolism shock

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2
Q

in the simplified view of the cardiovascular system.. the heart

A

serves as the pump

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3
Q

function of the heart

A

pushes blood with a lot of force

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4
Q

what does the right side of the heart do

A

pushes blood to the lungs to acquire oxygen

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5
Q

what does the left side of the heart do

A

pushes blood through the aorta, then to all body tissues

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6
Q

cardiogenic shock

A

body tissues don’t receive blood because of a faukty heart

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7
Q

what is usually the culrint of cardiogenic shock

A

the left side of the heart

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8
Q

coronary arteries

A

blood vessels that deliver blood to cardiac muscle and help them generate energy

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9
Q

what does a blockage of the coronary artery do&raquo_space;»>

A

failure of heart muscle (heart attack)

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10
Q

what does a heart attack lead to

A

to a failure of blood flow to other tissues, leading to shock

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11
Q

the five coronary arteries (rdlcl)

A

right coronary artery

distal right coronary artery

left main coronary artery

circumflex coronary artery

left anterior descending
coronary artery

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12
Q

what are the two types of heart attacks

A

ischemia, infarction

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13
Q

ischemia of heart muscle

A

partial blockage leads to a limited blood supply to the heart

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14
Q

in most cases of ischemia to the heart///////

A

the heart is still strong enough to keep a person alive and breathing

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15
Q

in ischemia the heart cannot work hard enough….

A

to beat fast when a person exercises

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16
Q

what happens when the heart exerts itself too hard

A

chest pain

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17
Q

chest pain

A

angina pectoris

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18
Q

infarction of heart muscle

A

comes for complete blockage and leads to a failure of heart muscle

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19
Q

infarction to the heart usually comes from

A

a blood clot that suddenly embeds itself in a coronary artery

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20
Q

because of their sudden nature, heart attack are termed

A

acute myocardial infarctions (AMIs)

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21
Q

AMIs will lead to…..

A

health problems and likely necrosis of heart muscle

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22
Q

what is the most important coronary artery

A

left anterior descending artery

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23
Q

what is the most important chamber of the heart

A

left ventricle»> pushes blood through aortic valve and into the rest of the body

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24
Q

widow maker

A

first 1-2 cm of the left anterior descending artery after it branches off the left main coronary artery

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25
Q

the human body should contain how much blood

A

5 litres

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26
Q

hypovolemic shock occurs when

A

the body drops significantly under 5 litres of blood

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27
Q

different reasons for hypovolemic shock

A

blood loss
plasma loss
fluid loss

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28
Q

blood loss in relation to hypovolemic shock

A

injury to the body causes blood to exit the body or spill into body cavities

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29
Q

plasma loss in relation to hypovolemic shock

A

burns to the skin causes the loss of plasma

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30
Q

fluid loss in relation to hypovolemic shock

A

dehydration, diarrhea, vomiting or sodium causes a loss of water from the bloodstream

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31
Q

in all cases of hypovolemic shock

A

the condition gets more extreme as more fluid is lost

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32
Q

of how much of the blood results in death in hypovolemic shock

A

50% +

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33
Q

classification of hemorrhage: as blood is lost

A

heart rate increases, blood pressure slows down, the CNS becomes confused and declines

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34
Q

what is done to reverse hypovolemic shock

A

IV fluids, plasma transfusions, and/or blood transfusion to replace lost blood volume

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35
Q

IV fluids

A

saline, or slighly salty water

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36
Q

what can’t the administration. IV fluids, plasma trnasfusions, blood transfusions can’t be done too quickly

A

patients with hypovolemic shock, especially the elderly begin showing weakness in heart muscle

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37
Q

if too mcuh fluid is administered treating hypovolemic shoock

A

there would be a backup of fluid because the heart can’t pump it fast enough

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38
Q

a backup of fluid because the heart can’t pump it fast enough will lead to

A

cardiogenic pulmonary edema

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39
Q

metabolic shock is unique because

A

not a failure of oxygen delivery… but a failure of glucose delivery

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40
Q

to look closer at metabolic shock»>

A

must look a regulation of glucose delivery

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41
Q

sugars are digested and&raquo_space;»

A

float through the body as glucose

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42
Q

cells have a chanel that allows glucose to enter

A

normally closed unless signaled by insulin

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43
Q

where in insulin made

A

in B-cells in the pancreas

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44
Q

when is insulin made and secreted

A

when glucose is detected in the blood stream

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45
Q

diabetes mellitus

A

disease characterized by a deficiency in insulin

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46
Q

type 1 diabetes is also knwon as

A

juevenile diabetes

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47
Q

type 1 diabetes

A

pancreas does not produce enough insulin for the body

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48
Q

type 2 diabetes is known as

A

adult onset diabetes

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49
Q

type 2 diabetes

A

body is desensitized to insulin»> result of obesity

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50
Q

why is type 2 diabetes usually the result of obesity

A

the body is too big or the pancreas is too weak to properly distribute insulin

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51
Q

what is gestational diabetes

A

a pregnant woman can’t produce enogh insulin for both herself and her unborn child> ends when pregnancy dies

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52
Q

what is the result of insufficient insulin

A

the body has poor regulation of its glucose levels

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53
Q

hyperglycemia in diabetics»>

A

too much sugar in the blood because it can’t blood

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54
Q

usually hyperglycemia leads to glucose being

A

taken in by the liver and stored in long chains of glycogen

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55
Q

in diabetes….. glucose in the blood

A

can’t enter liver cells and can’t be stored

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56
Q

what normally happens in hypoglycemia

A

body releases supplies of glycogen

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57
Q

in diabetes… glycogen in the liver

A

is never created

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58
Q

diabetic must eat several times a day or face

A

diabetic coma

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59
Q

without glucose to break down for enegry»»>

A

cells shift to the breakdown of lipids

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60
Q

lipids breakdown creates

A

toxic byproducts acetoacetic acid and acetone

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61
Q

acetoacetic acid and acetone are excreted through

A

the lungs and give off a fruity odor

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62
Q

if the body relys to much on lipid breakdown

A

too much acetoacetic acid» acidosis»> normal shock

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63
Q

excessive acidosis due to lipid breakdown

A

patients eventually fall unconscious»» diabetic coma

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64
Q

primary symptoms of diabetic coma

A

> > fruity breath

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65
Q

shocks of the airway

A

respiratory shock

anaphylactic shock

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66
Q

inhalation begins

A

with the nose, but can start with the mouth

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67
Q

after air being inhaled in the nose

A

in the nasal cavity.. air is warmed and moistened

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68
Q

what is after the nasal cavity

A

the pharynx

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69
Q

pharynx function

A

holds food and air

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70
Q

what is after the pharynx

A

epiglottis

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71
Q

epiglottis function

A

directs food down the esophagus and air down the larynx

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72
Q

what is after the epigottis&raquo_space;> larynx

A

trachea

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73
Q

trachea is heavily coated in

A

in mucus and cilia and filters the air before it enters the lungs

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74
Q

at the entrance of the lungs….

A

the trachea splits into left and right bronchi

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75
Q

bronchi split into

A

smaller and smaller bronchioles&raquo_space;> which then break into alveoli

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76
Q

bronchi can be categorized

A

based on how many branches have aready occured

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77
Q

at the base of the trachea there is …

A

division into left and right primary bronchi

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78
Q

the _____ bronchus is significantly bigger

A

right

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79
Q

all immediate divisions from the primary bronchi

A

secondary bronchi

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80
Q

how many secondary bronchi in the left lung

A

two

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81
Q

how many secondary bronchi in the right lung

A

three

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82
Q

which part of the lung has 3 lobes

A

right

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83
Q

branches from secondary bronchi

A

tertiary bronchi

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84
Q

branches after tertiary brinchi

A

4th order, 5th order etc….

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85
Q

when do bronchi become bronchioles…

A

no cartilage in the walls … only elastin

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86
Q

respiratory shock

A

failure of gas exchange in the lungs

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87
Q

respiratory shock is typically caused by

A

trauma to the lungs or airway

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88
Q

respiratory shock happens because

A

pleural effusion
atelectasis
pulmonary edema

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89
Q

pleural effusionn

A

pleural cavity has been compromised

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90
Q

atelectasis

A

air is not making it to the alveoli

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91
Q

pulmonary edema

A

alveoli are filled with fluid

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92
Q

each lung is surrounded by

A

two concentric sacs, together called the pleurae

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93
Q

more deep of sacs surrounding the lungs

A

visceral pleura

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94
Q

more superficial of sacs surrounding the lungs

A

parietal pleura

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95
Q

there should usually be what between pleurae and lungs

A

few millimeters of pleural fluid to lubricate (otherwise empty)

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96
Q

pneumothorax

A

air gets trapped in the pleural cavity

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97
Q

hemothorax

A

blood gets trapped in the pleural cavity

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98
Q

hemopneumothorax

A

Blood and air gets trapped in the pleural cavity

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99
Q

hydrothorax

A

water gets trapped in the pleural caviy

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100
Q

urinothorax

A

urine gets trapped in the pleural cavity

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101
Q

pyothorax

A

pus gets trapped in the pleural cavity

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102
Q

tension pneumothorax

A

special pneumothorax… pressure builds up in the pleura and pushes heart to the side… causing drop in blood pressure

103
Q

pleural effusion

A

any of the things where there is fluid in the lungs

104
Q

tension pneumothorax can be

A

immediately life-threatening… by causing other types of shock

105
Q

pneumothorax.. hemothorax and hemopneumothorax are called

A

punctured lunsg

106
Q

how to treat punctured lungs

A

inserting a chest tube

107
Q

atelectasis is a blockage

A

of the lungs, preventing air from making to the alveoli

108
Q

where does atelectasis usually happen

A

in bronchi or bronchioles

109
Q

reason 1 for atelectasis

A

mucus plug blocks the airway

110
Q

treatment for mucus plug blocking the airway

A

percussion on the chest

111
Q

reason 2 for atelectasis

A

physical blockkages (i=kids inhaling toys)

112
Q

treatment for physical blockages

A

bronchoscopy

113
Q

reason 3 for atelectasis

A

tumor in the lungs

114
Q

treatment for a tumor in the lungs

A

removal

115
Q

note atelectases

A

not all are that bad

116
Q

pulmonary edema is the buildup

A

buildup of fluid (most often blood ) in the lungs

117
Q

why is pulmoary edema different from a pleural effusion

A

pleural effusion is a buildup of fluid around the lungs

118
Q

two categories of pulmonary edema

A

cardiogenic

noncardiogenic

119
Q

cardiogenic edema

A

caused by low-functioning heart

120
Q

noncardiogeic edema

A

caused by variety of other factors

121
Q

in both cardiogenic and noncardiogenic edema….

A

alveoli fill with fluid and cannot facilitate the exchange of oxygen and carbon dioxide

122
Q

anaphylactic shock

A

deficiency in perfusion due to anaphylaxis

123
Q

anaphylaxis

A

severe allergic reaction

124
Q

people with allergies,…..

A

have immune systems that recognize mostly harmless substances, such as pollen, as danger

125
Q

in an allergic reaction.. the body releases

A

histamine

126
Q

histamine functions

A

as a neurotransmitter or hormone to activate many different responses in the body

127
Q

example of receptor histamine binds to

A

periphery receptor; caused bronchoconstriction»can’t breathe>shock

128
Q

histamine binds to

A

variety of receptors

129
Q

symptoms of histamine binding to receptors

A 
Hives
Vomitting
Diarrhea
Light-Headedness
Swelling of mouth / air way
shortness of breath
low blood pressure
abnormally slow or fast heart rate
130
Q

worst of histamine symptoms

A

swelling of the airway»> can’t inhale or exhale.» cant breathe» death

131
Q

antihistamines

A

antagonists for histamine receptors

132
Q

by blocking histamine receptors

A

block them from sending danger signals and inhibit stuff

133
Q

antihistamines specifically target which receptors

A

H1 receptors

134
Q

H1 receptors are found

A

in the peripheral NS and central NS

135
Q

first-generation antihistamines

A

passed through blood brain barrier and blocked H1 receptors everywhere

136
Q

H1 receptors in the CNS

A

wakefullness, appetite,

137
Q

second-generation antihistamines

A

can no longer pass through the blood brain barrier because they are lipophobic

138
Q

what particles are best at passing through the blood brain barrier

A

small, lipophilic, uncharged

139
Q

antihistamines are usually….

A

small. uncharged, mostly lipophilic

140
Q

distributive shock

A

failure of blood vessels to bring blood to the right place

141
Q

circulatory system can be broken into …

A

the pump, the container, the stuff

142
Q

distributive shock is a problem with

A

the container… it is too big

143
Q

what types of shock are caused by distributive shock

A

anaphylactic shock
neurogenic shock
Psychogenic Shock
Septic Shock

144
Q

Anaphylactic shock

A

deficiency in perfusion due to to anaphylaxis

145
Q

another important function of periphery H1 receptors

A

vasodilation

146
Q

H2 receptors are primarily

A

involved in vasodilation

147
Q

second scariest of symptoms cause by histamine

A

low blood pressure …. if it drops too low… a patient is at risk for distributive shock (even though the respratory shock is fixed)

148
Q

neurogenic and psychogenic shock come from

A

failure of the nervous system to control muscles that regulate blood vessels

149
Q

three types of muscle tissues

A

skeletal
smooth
cardiac

150
Q

skeletal muscle

A

can be voluntarily controlled and is found in and round important organs

151
Q

smooth muscle

A

cannot be voluntarily controlled and is found in and around important organs

152
Q

cardiac muscle

A

cannot be voluntarily controlled and is found only in the heart

153
Q

smooth muscles are found….

A

in blood vessels and control vasoconstriction or vasodilation

154
Q

vasodilation and vasoconstriction

A

crucial for blood pressure

155
Q

too much dilation

A

blood pressure drops

156
Q

too much contriction

A

blood pressure spikes

157
Q

distributive shock is caused by

A

excessive vasodilation

158
Q

how are smooth muscles controlled

A

not by CNS, by hormones

159
Q

the sympathetic pathway of smooth muclses releases

A

epinephrine and norepinephrine

160
Q

sympathetic pathway

A
  • Also called the “fight or flight” response

- Causes many effects, including vasoconstriction across most blood vessels and an increase in heart rate

161
Q

time sympathetic pathway

A

-Acts and dissipates in seconds

162
Q

parasympathetic pathway releases

A

acetylcholine (ACh)

163
Q

parasympathetic pathway

A

Also called the “feed or breed” response-Causes many effects, including vasodilation across most blood vessels and a decrease in heart rate-

164
Q

parasympathetic pathway time

A

acts and dissipates in minutes – longer

165
Q

signals for each the parasympathetic and sympathetic responses are carried from

A

the brain down the spinal cod to reach blood vessels i abdomen and legs

166
Q

when the spinal cord is severed..

A

each system is wiped out and the body loses control of all smooth muscles

167
Q

since the parasympathetic nervous system takes so long to dissipate

A

we see extreme vasodilation

168
Q

failure of nervous system to regulate_____

A

failure to regulate blood pressure… neurogenic shock

169
Q

vagus nerve

A

long nerve in the body responsible for stimulation of parasympathetic nervous system

170
Q

vagus nerve is stimulated

A

by many things

….. each released ACh and causes vasoldilation and slowed heart rate

171
Q

when the vagus nerve is triggered,,,,

A

vasovagal response

172
Q

vasovagal response

A

-results in low blood pressure, short term deficiency of oxygen to the brain»> syncope

173
Q

is the vasovagal response dead

A

almost always not

174
Q

syncope

A

fainting

175
Q

important chemical released in response to infection and help fight it

A

cytokines

176
Q

too big infection

A

too many cytokines released»> bad stuff

177
Q

usually cytokines are made to…

A

recruit white blood cells, which release more cytokines in a positive feedback loop

178
Q

cytokine positive feedback loop is supposed

A

to stay localized and get shutoff at a certain point

179
Q

in an infection gets too big…

A

the body does not shut down cytokines…. cytokine stor

180
Q

result of cytokine storm

A

widespread inflammation

181
Q

widespread inflammation from cytokine storm can lead to

A

ARDS» which can lead to death

182
Q

ARDS

A

acute respiratory distress syndrome

183
Q

cytokine storms can also lead to

A

severe damage to blood vessels when they dilate too much and for too long»>

184
Q

svsere damage to blood vssels leads to

A

blood spilling int the extracellular space

185
Q

blood spilling into the extracellular space causes

A

reddish slotches on the skin&raquo_space; petechiae

186
Q

blood spilling into extracellular space also leads to

A

decreased oxygen flow to cells» shock

187
Q

shock

A

lack of oxygen flow to cells

188
Q

if not treated… shock always leads to

A

cellular death

189
Q

associated words shock

A 
hypoxia
hypoxemia
ischemia
infarction
necrosis
190
Q

hypoxia

A

not enough oxygen in an area

191
Q

hypoxemia

A

not enough oxygen in the blood

192
Q

ischemia

A

not enough blood flow to an area

193
Q

infarction

A

complete blockage of blood flow to an area

194
Q

necrosis

A

tissue death due to lack of blood flow

195
Q

different cells can

A

survive for different lengths of time without oxygen

196
Q

skin cells without oxygen

A

live days to weeks

197
Q

muscle cells without oxygen

A

about 48 hours

198
Q

the most fragile cell type (n terms of oxygen flow)

A

neurons in the brain

199
Q

neurons without oxygen

A

irreversible damage after 10 minutes

200
Q

patients who clinically die for 10 minutes

A

will always have impaired mental function if resuscitated

201
Q

clinically dying

A

no breathing, no blood flow

202
Q

why will you have impaired mental function if you don’t have oxygen for 10 minutes

A
  • 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
203
Q

since neurons need ATP to maintain a delicate charge???

A

must aqquire this ATP through the breakdown of glucose

204
Q

since neurons cannot allow lipids to enter»»»>

A

they cannot use those for fuel

205
Q

BBB

A

Blood Brain Barrier

206
Q

8 types of shock

A

-Respiratory Shock-

Anaphylactic Shock-

Neurogenic Shock-

Cardiogenic Shock-

Hypovolemic Shock-

Metabolic Shock-

Psychogenic Shock-

Septic Shock

207
Q

why is shock bad

A

because all cells need oxygen supply

208
Q

deficiency of oxygen is called

A

hypoxia

209
Q

all cells need energy in the form of

A

ATP (adenosine triphosphate)

210
Q

two ways for cells to get energy

A

Aerobic Respiration

Anaerobic Respiration

211
Q

Aerobic Respiration breaks down and produces

A
  • breaks down glucose

- produce 36 ATP molecules

212
Q

aerobic respiration uses what and makes what byproducst

A

uses oxygen

non toxic byproducts: CO2 and H2O

213
Q

anaerobic glycolysis breaks down and produces

A
  • breaks down glucose

- produces 2 ATP per molecule

214
Q

anaerobic glycolysis uses what and makes what byproduct

A
  • doe NOT use oxygen

- produces the toxic byproduct lactic acid

215
Q

as lactic acid build up in cells

A

it begins to exit them through passive transport and enters the bloodstream instead

216
Q

lactate and lactic acid

A

are very similar ad can flip flop back and forth in equilibrium

217
Q

equilibrium point where lactate and lactic acid can flip flop

A

pH=4

218
Q

at physiological pH levels, almost all lactic acid in the body

A

has dissociated into lactate and H+

219
Q

so if there is lactic acid that has dissociated into lactate and H+……..

A

at normal body temperatures…. extra H+ is released

220
Q

a liquid’s acidity comes from

A

the concentration of H+ ions, more H+= more acidic

221
Q

so the H+ that comes form lactic acid

A

H+ from lactic acid mixes with the blood and lowers its pH

222
Q

condition where blood pH is too low

A

below 7.35

223
Q

where blood pH is too low…..

A

acidosis

224
Q

acidosis what happens to neurons

A

the resting potential of neurons is even lower than normal

225
Q

what happens when the resting potential of neurons is lower than normal

A

requires more excitatory signal to cause a nerve to fire

226
Q

if resting potential gets too low

A

nerves fire far too little»»» coma

227
Q

in alkalosis what happens to neurons

A

the resting potential of neurons is higher than normal

228
Q

when the resting potential of neurons is higher than normal

A

only a little excitation is necessary before a nerve fires

229
Q

if resting potential gets too high

A

nerves fire too much»» seizure

230
Q

what is something very essential to cellular survival

A

the sodium/potassium pump

231
Q

how does the sodium potassium pump work

A

against a concentration gradient and uses ATP

232
Q

what does the sodium/potassium pump move

A

3 sodium ions out of the cell while pumping two potassium ions in

233
Q

When the Na+/K+ pump fails……

A

cells build up extremely high levels of sodium inside

234
Q

when there is very high levels of sodium in cells

A

water rushes into cells from the environment through the principles of osmosis

235
Q

when water rushes into cells as a result of high sodium level…..

A

the cells swell to large sizes and grow increasingly unstable

236
Q

what are lysosomes

A

large bag of enzymes that serve as molecular scissors

237
Q

enzymes in lysosomes…

A

can cut almost all molecules

238
Q

what happens to lysosomes in reponse to decreased ATP supplies

A

lysosomes break apart and release enzymes to the cell

239
Q

usually lysosomal enzymes»>

A

are denatured at normal pH , only work at acidic pH levels

240
Q

when the cell’s pH is lower&raquo_space; from lack of oxygen»> lysosomal enzymes

A

can work when they escape and destroy the cell

241
Q

lysosome-mediated apoptosis is usually

A

a normal event in cells

242
Q

why is lysosome-mediated apoptosis bad in the case of shock

A

because a cell’s membrane ceases to function correctly

243
Q

why would a cell membrane not function correctly in lysosome-mediated apoptosis in the case of shock

A
  • the cell is too big and its membrane is spread thin

- the internal/external concentration gradients are wrong

244
Q

as a result of apoptosis during shock…..

A

leakage of cellular debris and lysosomal enzymes

245
Q

leakage of cellular debris and lysosomal enzymes as a result of apoptosis during shock will….

A

spread to nearby tissues through blood and leads to more cell death»»»leads to tissue death

246
Q

step 1 shock

A

Cells rely too much on anaerobic respiration for energy and build up large supplies of lactic acid

247
Q

step 2 shock

A

Lactic acid enters the bloodstream

248
Q

step 3 shock

A

Lactic acid dissociates

249
Q

step 4 shock

A

Hydrogen ions lower pH of blood (acidosis)-

250
Q

step 5 shock

A

Na+/K+ pumps fail to work in cell membranes

251
Q

step 6 shock

A

Lysosomes release their enzymes

252
Q

step 7 shock

A

Cells die and release debris into the bloodstream

253
Q

step 8 shock

A

The debris spreads and damages more and more tissue until death.

pathophysiology (24 decks)

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