General Principles of Pathophysiology Energy Metabolism PerfusionShock PerfusionShock.
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Transcript of General Principles of Pathophysiology Energy Metabolism PerfusionShock PerfusionShock.
General Principles of General Principles of PathophysiologyPathophysiologyGeneral Principles of General Principles of PathophysiologyPathophysiology
Energy MetabolismEnergy Metabolism
PerfusionPerfusion
ShockShock
Energy MetabolismEnergy Metabolism
PerfusionPerfusion
ShockShock
TopicsTopicsTopicsTopics
Define shock in terms of cellular Define shock in terms of cellular functionfunction
Review the requirements for adequate Review the requirements for adequate cellular perfusion (Fick principle)cellular perfusion (Fick principle)
Review the mechanisms for starling’s Review the mechanisms for starling’s lawlawPreload vs. afterloadPreload vs. afterloadMuscle contractionMuscle contraction
Define shock in terms of cellular Define shock in terms of cellular functionfunction
Review the requirements for adequate Review the requirements for adequate cellular perfusion (Fick principle)cellular perfusion (Fick principle)
Review the mechanisms for starling’s Review the mechanisms for starling’s lawlawPreload vs. afterloadPreload vs. afterloadMuscle contractionMuscle contraction
Topics ContinuedTopics ContinuedTopics ContinuedTopics Continued
Discuss the mechanisms for oxygen Discuss the mechanisms for oxygen transporttransportoxyhemoglobin dissociation curveoxyhemoglobin dissociation curve
Define the stages of shockDefine the stages of shock Describe different causes of shockDescribe different causes of shock Define multiple organ dysfunction Define multiple organ dysfunction
syndromesyndrome
Discuss the mechanisms for oxygen Discuss the mechanisms for oxygen transporttransportoxyhemoglobin dissociation curveoxyhemoglobin dissociation curve
Define the stages of shockDefine the stages of shock Describe different causes of shockDescribe different causes of shock Define multiple organ dysfunction Define multiple organ dysfunction
syndromesyndrome
Shock DefinedShock DefinedShock DefinedShock Defined
Inadequate tissue perfusionInadequate tissue perfusion Anaerobic metabolismAnaerobic metabolism
Inadequate tissue perfusionInadequate tissue perfusion Anaerobic metabolismAnaerobic metabolism
Final Common Pathway!Final Common Pathway!Final Common Pathway!Final Common Pathway!
Aerobic MetabolismAerobic MetabolismAerobic MetabolismAerobic Metabolism
6 O2
GLUCOSE
METABOLISM
6 CO2
6 H2O
36 ATP
HEAT (417 kcal)
Anaerobic MetabolismAnaerobic MetabolismAnaerobic MetabolismAnaerobic Metabolism
GLUCOSE METABOLISM
2 LACTIC ACID
2 ATP
HEAT (32 kcal)
Anaerobic? So What?Anaerobic? So What?Anaerobic? So What?Anaerobic? So What?
InadequateInadequateCellularCellular
OxygenationOxygenation
InadequateInadequateCellularCellular
OxygenationOxygenation
AnaerobicAnaerobicMetabolismMetabolism
AnaerobicAnaerobicMetabolismMetabolism
MetabolicMetabolicFailureFailure
MetabolicMetabolicFailureFailure
MetabolicMetabolicAcidosisAcidosis
MetabolicMetabolicAcidosisAcidosis
InadequateInadequateEnergyEnergy
ProductionProduction
InadequateInadequateEnergyEnergy
ProductionProduction
Lactic AcidLactic AcidProductionProduction
Lactic AcidLactic AcidProductionProduction
Cell Death!Cell Death!Cell Death!Cell Death!
Homeostasis is maintenance of Homeostasis is maintenance of balancebalanceHomeostasis is maintenance of Homeostasis is maintenance of balancebalance
Requires proper functioning systemsRequires proper functioning systemsCardiovascularCardiovascularRespiratoryRespiratoryRenalRenal
Requires proper functioning systemsRequires proper functioning systemsCardiovascularCardiovascularRespiratoryRespiratoryRenalRenal
Physiology of PerfusionPhysiology of PerfusionPhysiology of PerfusionPhysiology of Perfusion
Dependant on 3 components of Dependant on 3 components of circulatory systemcirculatory systemPumpPumpFluidFluidContainerContainer
Dependant on 3 components of Dependant on 3 components of circulatory systemcirculatory systemPumpPumpFluidFluidContainerContainer
Factors Affecting The PumpFactors Affecting The PumpFactors Affecting The PumpFactors Affecting The Pump
PreloadPreload Contractile forceContractile force
Frank-starling mechanismFrank-starling mechanism AfterloadAfterload
PreloadPreload Contractile forceContractile force
Frank-starling mechanismFrank-starling mechanism AfterloadAfterload
Muscle AnatomyMuscle AnatomyMuscle AnatomyMuscle Anatomy
Contraction: Sliding FilamentsContraction: Sliding FilamentsContraction: Sliding FilamentsContraction: Sliding Filaments
image from: http://www.accessexcellence.com/AB/GG/muscle_Contract.html
What Is Blood Pressure?What Is Blood Pressure?What Is Blood Pressure?What Is Blood Pressure?
BP = Cardiac Output BP = Cardiac Output X Systemic Vascular ResistanceX Systemic Vascular Resistance
BP = Cardiac Output BP = Cardiac Output X Systemic Vascular ResistanceX Systemic Vascular Resistance
CO = Stroke VolumeCO = Stroke VolumeX Heart RateX Heart Rate
CO = Stroke VolumeCO = Stroke VolumeX Heart RateX Heart Rate
What Affects Blood Pressure?What Affects Blood Pressure?What Affects Blood Pressure?What Affects Blood Pressure?
ANS balanceANS balance ContractilityContractility
PreloadPreloadStarling’s lawStarling’s law
AfterloadAfterload
ANS balanceANS balance ContractilityContractility
PreloadPreloadStarling’s lawStarling’s law
AfterloadAfterload
Autonomic Nervous System Autonomic Nervous System Review…Review…Autonomic Nervous System Autonomic Nervous System Review…Review…
Quiz Time! Yeah!Quiz Time! Yeah!Quiz Time! Yeah!Quiz Time! Yeah!
JeopardyJeopardyJeopardyJeopardy
Controls vegetative functions,exits the Controls vegetative functions,exits the CNS at high in the neck and low in the CNS at high in the neck and low in the back.back.
Controls vegetative functions,exits the Controls vegetative functions,exits the CNS at high in the neck and low in the CNS at high in the neck and low in the back.back.
What is the What is the parasympathetic nervous system?parasympathetic nervous system?
What is the What is the parasympathetic nervous system?parasympathetic nervous system?
JeopardyJeopardyJeopardyJeopardy
The chief neurotransmitter of the The chief neurotransmitter of the sympathetic nervous system.sympathetic nervous system.
The chief neurotransmitter of the The chief neurotransmitter of the sympathetic nervous system.sympathetic nervous system.
What is What is Norepinephrine?Norepinephrine?
What is What is Norepinephrine?Norepinephrine?
JeopardyJeopardyJeopardyJeopardy
The ‘cutesy’ name for the The ‘cutesy’ name for the parasympathetic nervous system.parasympathetic nervous system.
The ‘cutesy’ name for the The ‘cutesy’ name for the parasympathetic nervous system.parasympathetic nervous system.
What is What is ‘‘Feed or Breed’?Feed or Breed’?
What is What is ‘‘Feed or Breed’?Feed or Breed’?
JeopardyJeopardyJeopardyJeopardy
Two types of parasympathetic receptors.Two types of parasympathetic receptors.Two types of parasympathetic receptors.Two types of parasympathetic receptors.
What is nicotinic (NMJ)What is nicotinic (NMJ)and muscarinic (organs)?and muscarinic (organs)?What is nicotinic (NMJ)What is nicotinic (NMJ)and muscarinic (organs)?and muscarinic (organs)?
JeopardyJeopardyJeopardyJeopardy
Two types classes of sympathetic Two types classes of sympathetic receptors.receptors.
Two types classes of sympathetic Two types classes of sympathetic receptors.receptors.
What is What is alpha and beta?alpha and beta?
What is What is alpha and beta?alpha and beta?
JeopardyJeopardyJeopardyJeopardy
The ‘cutesy name’ for the sympathetic The ‘cutesy name’ for the sympathetic nervous system.nervous system.
The ‘cutesy name’ for the sympathetic The ‘cutesy name’ for the sympathetic nervous system.nervous system.
What is What is ‘‘fight or flight’?fight or flight’?
What is What is ‘‘fight or flight’?fight or flight’?
JeopardyJeopardyJeopardyJeopardy
Stimulation of this receptor causes an Stimulation of this receptor causes an increase in peripheral vasoconstriction.increase in peripheral vasoconstriction.
Stimulation of this receptor causes an Stimulation of this receptor causes an increase in peripheral vasoconstriction.increase in peripheral vasoconstriction.
What is alpha 1?What is alpha 1?What is alpha 1?What is alpha 1?
JeopardyJeopardyJeopardyJeopardy
Stimulation of this receptor causes an Stimulation of this receptor causes an increase in myocardial contractility.increase in myocardial contractility.
Stimulation of this receptor causes an Stimulation of this receptor causes an increase in myocardial contractility.increase in myocardial contractility.
What is beta 1?What is beta 1?What is beta 1?What is beta 1?
JeopardyJeopardyJeopardyJeopardy
Stimulation of this receptor causes an Stimulation of this receptor causes an increase in bronchodilation.increase in bronchodilation.
Stimulation of this receptor causes an Stimulation of this receptor causes an increase in bronchodilation.increase in bronchodilation.
What is beta 2?What is beta 2?What is beta 2?What is beta 2?
JeopardyJeopardyJeopardyJeopardy
Stimulation of this receptor causes a Stimulation of this receptor causes a decrease in the sympathetic activation.decrease in the sympathetic activation.
Stimulation of this receptor causes a Stimulation of this receptor causes a decrease in the sympathetic activation.decrease in the sympathetic activation.
What is alpha 2?What is alpha 2?What is alpha 2?What is alpha 2?
JeopardyJeopardyJeopardyJeopardy
Two types of parasympathetic receptors.Two types of parasympathetic receptors.Two types of parasympathetic receptors.Two types of parasympathetic receptors.
What is nicotinic (NMJ)What is nicotinic (NMJ)and muscarinic (organs).and muscarinic (organs).What is nicotinic (NMJ)What is nicotinic (NMJ)and muscarinic (organs).and muscarinic (organs).
Changes in Afterload and PreloadChanges in Afterload and PreloadChanges in Afterload and PreloadChanges in Afterload and Preload
Peripheral Peripheral vasoconstriction…vasoconstriction…
Peripheral Peripheral vasoconstriction…vasoconstriction…
peripheral vascular peripheral vascular resistance…resistance…
peripheral vascular peripheral vascular resistance…resistance…
afterload…afterload… afterload…afterload…
blood pressure.blood pressure. blood pressure.blood pressure.
Changes in Afterload and PreloadChanges in Afterload and PreloadChanges in Afterload and PreloadChanges in Afterload and Preload
Peripheral Peripheral vasodilation…vasodilation…
Peripheral Peripheral vasodilation…vasodilation…
peripheral vascular peripheral vascular resistance…resistance…
peripheral vascular peripheral vascular resistance…resistance…
afterload…afterload… afterload…afterload…
blood pressure.blood pressure. blood pressure.blood pressure.
Changes in Afterload and PreloadChanges in Afterload and PreloadChanges in Afterload and PreloadChanges in Afterload and Preload
fluid volume…fluid volume… fluid volume…fluid volume…
preload…preload… preload…preload…
contractility contractility (Starling’s Law)…(Starling’s Law)…
contractility contractility (Starling’s Law)…(Starling’s Law)…
cardiac output.cardiac output. cardiac output.cardiac output. blood pressure.blood pressure. blood pressure.blood pressure.
Changes in Afterload and PreloadChanges in Afterload and PreloadChanges in Afterload and PreloadChanges in Afterload and Preload
fluid volume…fluid volume… fluid volume…fluid volume…
preload…preload… preload…preload…
contractility contractility (Starling’s Law)…(Starling’s Law)…
contractility contractility (Starling’s Law)…(Starling’s Law)…
cardiac output.cardiac output. cardiac output.cardiac output. blood pressure.blood pressure. blood pressure.blood pressure.
FluidFluidFluidFluid
Must have adequate Must have adequate amounts of amounts of hemoglobinhemoglobin
Must have adequate Must have adequate intravascular volumeintravascular volume
Must have adequate Must have adequate amounts of amounts of hemoglobinhemoglobin
Must have adequate Must have adequate intravascular volumeintravascular volume
Maintenance of Fluid VolumeMaintenance of Fluid VolumeMaintenance of Fluid VolumeMaintenance of Fluid Volume
Renin-Angiotensin-Aldosterone system.Renin-Angiotensin-Aldosterone system.Works through kidneys to regulate balance Works through kidneys to regulate balance
of Naof Na++ and water. and water.
Renin-Angiotensin-Aldosterone system.Renin-Angiotensin-Aldosterone system.Works through kidneys to regulate balance Works through kidneys to regulate balance
of Naof Na++ and water. and water.
Renin-Angiotensin-AldosteroneRenin-Angiotensin-AldosteroneRenin-Angiotensin-AldosteroneRenin-Angiotensin-Aldosterone
PlasmaPlasmavolumevolume
PlasmaPlasmavolumevolume
[Na+][Na+] [Na+][Na+]
KidneyKidney(juxtaglomerular(juxtaglomerular
apparatus)apparatus)
KidneyKidney(juxtaglomerular(juxtaglomerular
apparatus)apparatus)Detected by
Releases
ReninReninReninRenin
AngiotensinogenAngiotensin I…Angiotensin I…Angiotensin I…Angiotensin I…
Converts
&/Or
Via ACE(AngiotensinConvertingEnzyme)
Angiotensin II…Angiotensin II…Angiotensin II…Angiotensin II…
Renin-Angiotensin-AldosteroneRenin-Angiotensin-AldosteroneRenin-Angiotensin-AldosteroneRenin-Angiotensin-Aldosterone
Angiotensin II…Angiotensin II…Angiotensin II…Angiotensin II…
vasoconstrictionvasoconstriction vasoconstrictionvasoconstriction PVRPVR PVRPVR
BP!BP! BP!BP!
thirstthirst thirstthirst
FluidFluidvolumevolume
FluidFluidvolumevolume
ADHADH(anti-diuretic(anti-diuretic
hormone)hormone)
ADHADH(anti-diuretic(anti-diuretic
hormone)hormone)
AdrenalAdrenalcortexcortex
AdrenalAdrenalcortexcortex
Releases
AldosteroneAldosteroneAldosteroneAldosteroneNa+Na+
reabsorptionreabsorption
Na+Na+reabsorptionreabsorption
HemostasisHemostasisHemostasisHemostasis
The stoppage of bleeding.The stoppage of bleeding. Three methodsThree methods
Vascular constrictionVascular constrictionPlatelet plug formationPlatelet plug formationCoagulationCoagulation
The stoppage of bleeding.The stoppage of bleeding. Three methodsThree methods
Vascular constrictionVascular constrictionPlatelet plug formationPlatelet plug formationCoagulationCoagulation
CoagulationCoagulationCoagulationCoagulation
Formation of blood clotsFormation of blood clots Prothrombin activatorProthrombin activator Prothrombin Prothrombin thrombin thrombin Fibrinogen Fibrinogen fibrin fibrin Clot retractionClot retraction
Formation of blood clotsFormation of blood clots Prothrombin activatorProthrombin activator Prothrombin Prothrombin thrombin thrombin Fibrinogen Fibrinogen fibrin fibrin Clot retractionClot retraction
FibrinolysisFibrinolysisFibrinolysisFibrinolysis
PlasminogenPlasminogen Tissue plasminogen activator (tPA)Tissue plasminogen activator (tPA) PlasminPlasmin
PlasminogenPlasminogen Tissue plasminogen activator (tPA)Tissue plasminogen activator (tPA) PlasminPlasmin
Disseminated Intravascular Disseminated Intravascular CoagulationCoagulationDisseminated Intravascular Disseminated Intravascular CoagulationCoagulation
““A systemic thrombohemorrhagic disorder A systemic thrombohemorrhagic disorder … with evidence of:… with evidence of:
1)1) Procoagulant activationProcoagulant activation
2)2) Fibrinolytic activationFibrinolytic activation
3)3) Inhibitor consumptionInhibitor consumption
4)4) End-organ failure”End-organ failure”
““A systemic thrombohemorrhagic disorder A systemic thrombohemorrhagic disorder … with evidence of:… with evidence of:
1)1) Procoagulant activationProcoagulant activation
2)2) Fibrinolytic activationFibrinolytic activation
3)3) Inhibitor consumptionInhibitor consumption
4)4) End-organ failure”End-organ failure”
Bick, R.L. Seminars in Thrombosis and Hemostasis 1996
Pathophysiology of DICPathophysiology of DICPathophysiology of DICPathophysiology of DIC
Uncontrolled acceleration of clotting Uncontrolled acceleration of clotting cascadecascade
Small vessel occlusionSmall vessel occlusion Organ necrosisOrgan necrosis Depletion of clotting factorsDepletion of clotting factors Activation of fibrinolysisActivation of fibrinolysis Ultimately severe systematic Ultimately severe systematic
hemorrhagehemorrhage
Uncontrolled acceleration of clotting Uncontrolled acceleration of clotting cascadecascade
Small vessel occlusionSmall vessel occlusion Organ necrosisOrgan necrosis Depletion of clotting factorsDepletion of clotting factors Activation of fibrinolysisActivation of fibrinolysis Ultimately severe systematic Ultimately severe systematic
hemorrhagehemorrhage
ContainerContainerContainerContainer
Vasculature is continuous, closed and Vasculature is continuous, closed and pressurized systempressurized system
Microcirculation responds to local tissue Microcirculation responds to local tissue needsneeds
Blood flow dependent on PVRBlood flow dependent on PVR
Vasculature is continuous, closed and Vasculature is continuous, closed and pressurized systempressurized system
Microcirculation responds to local tissue Microcirculation responds to local tissue needsneeds
Blood flow dependent on PVRBlood flow dependent on PVR
Fick PrincipleFick PrincipleFick PrincipleFick Principle
Effective movement and utilization of OEffective movement and utilization of O2 2
dependent on:dependent on:Adequate fioAdequate fio22
Appropriate OAppropriate O22 diffusion into bloodstream diffusion into bloodstream
Adequate number of RBCsAdequate number of RBCsProper tissue perfusionProper tissue perfusionEfficient hemoglobin ‘loading’Efficient hemoglobin ‘loading’
Effective movement and utilization of OEffective movement and utilization of O2 2
dependent on:dependent on:Adequate fioAdequate fio22
Appropriate OAppropriate O22 diffusion into bloodstream diffusion into bloodstream
Adequate number of RBCsAdequate number of RBCsProper tissue perfusionProper tissue perfusionEfficient hemoglobin ‘loading’Efficient hemoglobin ‘loading’
Fick PrincipleFick PrincipleFick PrincipleFick Principle
Perfusion = Arterial OPerfusion = Arterial O22 Content - Content -
Venous OVenous O22 Content Content Affected by:Affected by:
Hemoglobin levelsHemoglobin levelscirculation of RBCscirculation of RBCsdistance between alveoli and capillariesdistance between alveoli and capillariespH and temperaturepH and temperature
Perfusion = Arterial OPerfusion = Arterial O22 Content - Content -
Venous OVenous O22 Content Content Affected by:Affected by:
Hemoglobin levelsHemoglobin levelscirculation of RBCscirculation of RBCsdistance between alveoli and capillariesdistance between alveoli and capillariespH and temperaturepH and temperature
Onloading Oxygen in LungsOnloading Oxygen in LungsOnloading Oxygen in LungsOnloading Oxygen in Lungs
Pressure
Saturation
oxyhemeglobin
deoxyhemeglobin
pH 7.4
pH 7.45
pH shifts curve to pH shifts curve to leftleft ‘ ‘onloading’ in lungsonloading’ in lungs
pH shifts curve to pH shifts curve to leftleft ‘ ‘onloading’ in lungsonloading’ in lungs
Remember:Remember:COCO22 [H [H++]]
Remember:Remember:COCO22 [H [H++]]
Offloading Oxygen in TissuesOffloading Oxygen in TissuesOffloading Oxygen in TissuesOffloading Oxygen in Tissues
Pressure
Saturation
oxyhemeglobin
deoxyhemeglobin
pH 7.4
pH 7.35
pH shifts curve to pH shifts curve to rightright ‘ ‘offloading’ to tissuesoffloading’ to tissues
pH shifts curve to pH shifts curve to rightright ‘ ‘offloading’ to tissuesoffloading’ to tissues
Remember:Remember:COCO22 [H [H++]]
Remember:Remember:COCO22 [H [H++]]
Causes of Inadequate PerfusionCauses of Inadequate PerfusionCauses of Inadequate PerfusionCauses of Inadequate Perfusion
Inadequate pumpInadequate pump Inadequate preloadInadequate preload Poor contractilityPoor contractility Excessive afterloadExcessive afterload Inadequate heart rateInadequate heart rate
Inadequate fluid volumeInadequate fluid volume HypovolemiaHypovolemia
Inadequate containerInadequate container Excessive dilationExcessive dilation Inadequate systematic vascular resistanceInadequate systematic vascular resistance
Inadequate pumpInadequate pump Inadequate preloadInadequate preload Poor contractilityPoor contractility Excessive afterloadExcessive afterload Inadequate heart rateInadequate heart rate
Inadequate fluid volumeInadequate fluid volume HypovolemiaHypovolemia
Inadequate containerInadequate container Excessive dilationExcessive dilation Inadequate systematic vascular resistanceInadequate systematic vascular resistance
Responses to ShockResponses to ShockResponses to ShockResponses to Shock
Normal compensation includes:Normal compensation includes:Progressive vasoconstrictionProgressive vasoconstrictionIncreased blood flow to major organsIncreased blood flow to major organsIncreased cardiac outputIncreased cardiac outputIncreased respiratory rate and volumeIncreased respiratory rate and volumeDecreased urine outputDecreased urine output
Normal compensation includes:Normal compensation includes:Progressive vasoconstrictionProgressive vasoconstrictionIncreased blood flow to major organsIncreased blood flow to major organsIncreased cardiac outputIncreased cardiac outputIncreased respiratory rate and volumeIncreased respiratory rate and volumeDecreased urine outputDecreased urine output
Cellular Response to ShockCellular Response to ShockCellular Response to ShockCellular Response to Shock
TissueTissueperfusionperfusion
TissueTissueperfusionperfusion
NaNa++ Pump PumpFunctionFunction
NaNa++ Pump PumpFunctionFunction
ATPATPsynthesissynthesis
ATPATPsynthesissynthesis
AnaerobicAnaerobicmetabolismmetabolism
AnaerobicAnaerobicmetabolismmetabolism
Cellular edemaCellular edema Vascular volumeVascular volume
Cellular edemaCellular edema Vascular volumeVascular volume
Impaired cellularImpaired cellularmetabolismmetabolism
Impaired cellularImpaired cellularmetabolismmetabolism
OO22
useuse
OO22
useuse
Intracellular NaIntracellular Na++
& water& water
Intracellular NaIntracellular Na++
& water& water
Impaired Impaired glucose glucose
usageusage
Impaired Impaired glucose glucose
usageusage
Stimulation of Stimulation of clotting cascade & clotting cascade &
inflammatoryinflammatoryresponseresponse
Stimulation of Stimulation of clotting cascade & clotting cascade &
inflammatoryinflammatoryresponseresponse
Stages of ShockStages of ShockStages of ShockStages of Shock
CompensatedCompensated UncompensatedUncompensated IrreversibleIrreversible
CompensatedCompensated UncompensatedUncompensated IrreversibleIrreversible
Compensated ShockCompensated ShockCompensated ShockCompensated Shock
Defense mechanisms are successful in Defense mechanisms are successful in maintaining perfusionmaintaining perfusion
PresentationPresentationTachycardiaTachycardiaDecreased skin perfusionDecreased skin perfusionAltered mental statusAltered mental status
Defense mechanisms are successful in Defense mechanisms are successful in maintaining perfusionmaintaining perfusion
PresentationPresentationTachycardiaTachycardiaDecreased skin perfusionDecreased skin perfusionAltered mental statusAltered mental status
Uncompenstated ShockUncompenstated ShockUncompenstated ShockUncompenstated Shock
Defense mechanisms begin to failDefense mechanisms begin to fail PresentationPresentation
HypotensionHypotensionProlonged Cap refillProlonged Cap refillMarked increase in heart rateMarked increase in heart rateRapid, thready pulseRapid, thready pulseAgitation, restlessness, confusionAgitation, restlessness, confusion
Defense mechanisms begin to failDefense mechanisms begin to fail PresentationPresentation
HypotensionHypotensionProlonged Cap refillProlonged Cap refillMarked increase in heart rateMarked increase in heart rateRapid, thready pulseRapid, thready pulseAgitation, restlessness, confusionAgitation, restlessness, confusion
Irreversible ShockIrreversible ShockIrreversible ShockIrreversible Shock
Complete failure of compensatory Complete failure of compensatory mechanismsmechanisms
Death even in presence of resuscitationDeath even in presence of resuscitation
Complete failure of compensatory Complete failure of compensatory mechanismsmechanisms
Death even in presence of resuscitationDeath even in presence of resuscitation
Types of ShockTypes of ShockTypes of ShockTypes of Shock
HypovolemicHypovolemic CardiogenicCardiogenic NeurogenicNeurogenic AnaphylacticAnaphylactic SepticSeptic
HypovolemicHypovolemic CardiogenicCardiogenic NeurogenicNeurogenic AnaphylacticAnaphylactic SepticSeptic
Hypovolemic ShockHypovolemic ShockHypovolemic ShockHypovolemic Shock
““Fluid failure”Fluid failure” Decreased intravascular volumeDecreased intravascular volume Causes?Causes? ““Third spacing”Third spacing”
““Fluid failure”Fluid failure” Decreased intravascular volumeDecreased intravascular volume Causes?Causes? ““Third spacing”Third spacing”
Cardiogenic ShockCardiogenic ShockCardiogenic ShockCardiogenic Shock
COCO COCOR.A.S.R.A.S.ActivationActivation
R.A.S.R.A.S.ActivationActivation
DyspneaDyspnea DyspneaDyspnea
OO22
supplysupply
OO22
supplysupply
Volume/Volume/PreloadPreload
Volume/Volume/PreloadPreload
SVRSVR SVRSVR
PeripheralPeripheral& pulmonary& pulmonary
edemaedema
PeripheralPeripheral& pulmonary& pulmonary
edemaedemaImpairedImpaired
myocardial functionmyocardial function
ImpairedImpairedmyocardial functionmyocardial function
MyocardialMyocardialOO22 demand demand
MyocardialMyocardialOO22 demand demand
CatecholamineCatecholamineReleaseRelease
CatecholamineCatecholamineReleaseRelease
Neurogenic ShockNeurogenic ShockNeurogenic ShockNeurogenic Shock
Sympathetic ToneSympathetic ToneOrOr
Parasympathetic ToneParasympathetic Tone
Sympathetic ToneSympathetic ToneOrOr
Parasympathetic ToneParasympathetic Tone
Vascular ToneVascular ToneVascular ToneVascular Tone
Massive VasodilationMassive VasodilationMassive VasodilationMassive Vasodilation
SVR & PreloadSVR & Preload SVR & PreloadSVR & Preload Cardiac OutputCardiac Output Cardiac OutputCardiac Output
TissueTissueperfusionperfusion
TissueTissueperfusionperfusion
Anaphylactic ShockAnaphylactic ShockAnaphylactic ShockAnaphylactic Shock
““Container failure”Container failure” Massive & systemic allergic reactionMassive & systemic allergic reaction Large release of histamineLarge release of histamine Increases membrane permeability & Increases membrane permeability &
vasodilationvasodilation
““Container failure”Container failure” Massive & systemic allergic reactionMassive & systemic allergic reaction Large release of histamineLarge release of histamine Increases membrane permeability & Increases membrane permeability &
vasodilationvasodilation
Septic ShockSeptic ShockSeptic ShockSeptic Shock
““Container failure”Container failure” Systemic infectionSystemic infection
““Container failure”Container failure” Systemic infectionSystemic infection
Multiple Organ Dysfunction Multiple Organ Dysfunction SystemSystemMultiple Organ Dysfunction Multiple Organ Dysfunction SystemSystem
Progressive dysfunction of two or more Progressive dysfunction of two or more organ systemsorgan systems
Caused by uncontrolled inflammatory Caused by uncontrolled inflammatory response to injury or illnessresponse to injury or illnessTypically sepsisTypically sepsis
Progressive dysfunction of two or more Progressive dysfunction of two or more organ systemsorgan systems
Caused by uncontrolled inflammatory Caused by uncontrolled inflammatory response to injury or illnessresponse to injury or illnessTypically sepsisTypically sepsis
ReferencesReferencesReferencesReferences
New York Presbyterian hospital hypertension center:New York Presbyterian hospital hypertension center: Http://pc101186.Med.Cornell.Http://pc101186.Med.Cornell.eduedu//htchomehtchome//htbkhtbk//HtbkindexHtbkindex..
htmhtm Biographics Gallery: Biographics Gallery: http://www.http://www.accessexcellenceaccessexcellence
.com/AB/GG/#Anchor-Building-11481.com/AB/GG/#Anchor-Building-11481 RAS (Renin-Angiotensin-Aldosterone System):RAS (Renin-Angiotensin-Aldosterone System):
http://www.science.mcmaster.ca/Biology/4S03/RAS.HTMhttp://www.science.mcmaster.ca/Biology/4S03/RAS.HTM A graduate student’s hypertension page:A graduate student’s hypertension page:
http://www.teaching-biomed.man.ac.uk/student_projects/2http://www.teaching-biomed.man.ac.uk/student_projects/2000/mnpm6ven/default.htm000/mnpm6ven/default.htm
New York Presbyterian hospital hypertension center:New York Presbyterian hospital hypertension center: Http://pc101186.Med.Cornell.Http://pc101186.Med.Cornell.eduedu//htchomehtchome//htbkhtbk//HtbkindexHtbkindex..
htmhtm Biographics Gallery: Biographics Gallery: http://www.http://www.accessexcellenceaccessexcellence
.com/AB/GG/#Anchor-Building-11481.com/AB/GG/#Anchor-Building-11481 RAS (Renin-Angiotensin-Aldosterone System):RAS (Renin-Angiotensin-Aldosterone System):
http://www.science.mcmaster.ca/Biology/4S03/RAS.HTMhttp://www.science.mcmaster.ca/Biology/4S03/RAS.HTM A graduate student’s hypertension page:A graduate student’s hypertension page:
http://www.teaching-biomed.man.ac.uk/student_projects/2http://www.teaching-biomed.man.ac.uk/student_projects/2000/mnpm6ven/default.htm000/mnpm6ven/default.htm