Shocks

Question 1

First stage of shock and what happens?

Answer 1

Initial
Body uses anaerobic metabolism

Question 2

Second stage of shock and what happens?

Answer 2

Compensatory

Reversible
^bp^co^perfusion
Epinephrine and NE ^vasoconstriction

Ras kidneys release renin, stimulates circulating angiotensinogen to turn into angiotensin 1, then ACE catalyses angiotensin 1 to angiotensin 2.
Ang 2 causes vasoconstriction

Also acts on adrenal cortex and causes release of aldosterone that causes sodium reabsorption.

Posterior pituitary recognises body is trying to retain water and secretes ADH that prevents water excretion.

Question 3

Third stage of shock and what happens?

Answer 3

Progressive, no compensation
⬇️co ⬆️capillary permeability (third spacing)
Neuro, MAP <60, ⬇️CPP, slow speech, confused, agitated, ⬇️reaction
Lungs, ^permeability, fluid in alveoli, ARDS,
❤️ vtach, vfib, (⬇️o2 to SA node, AV node, PLUS ⬇️ o2 to muscle cells therefore AMI
Kidneys ⬇️UO, ^BUN, Cr, and wastes (aka acids) as kidneys can’t excrete hco3
Gut loses its protective hco3, therefore ulcers and GI bleeding.
Liver not filtering, increased wastes, (bili, ammonia) infection(bacteria in blood) less clotting = DIC (micro-clots in vessels that wastes platelets and clotting factors)

Needs FAST PROACTIVE TREATMENT

Question 4

Fourth stage of shock and what happens?

Answer 4

Refractory
Unmanageable, irreversible, death

All organs shut down, ⬇️CPP, ^waste, ⬇️renal, DIC, ⬇️❤️ until everything stops