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In the context of hemorrhagic events, which of the following scenarios exemplifies an instance of internal hemorrhage with the most direct life-threatening potential?
In the context of hemorrhagic events, which of the following scenarios exemplifies an instance of internal hemorrhage with the most direct life-threatening potential?
- Hemoarthrosis in the knee joint of a patient with advanced osteoarthritis, limiting mobility.
- Hemopericardium resulting from a penetrating chest trauma, rapidly impeding cardiac function. (correct)
- Ecchymoses present on the skin of an elderly patient undergoing anticoagulant therapy after a fall.
- Petechial hemorrhages observed on the extremities following a mild allergic reaction.
A patient presents with hypotension, tachycardia, and altered mental status following a severe motor vehicle accident. Initial assessment reveals significant pallor and diaphoresis. Given the classification of shock stages, which of the following compensatory mechanisms would be MOST indicative of the non-progressive (compensated) stage?
A patient presents with hypotension, tachycardia, and altered mental status following a severe motor vehicle accident. Initial assessment reveals significant pallor and diaphoresis. Given the classification of shock stages, which of the following compensatory mechanisms would be MOST indicative of the non-progressive (compensated) stage?
- Marked decrease in urine output with elevated serum creatinine and blood urea nitrogen (BUN) levels.
- Vasoconstriction of blood vessels in non-essential organs to maintain blood flow to the heart and brain. (correct)
- Progressive decrease in blood pressure despite fluid resuscitation.
- Depressed respiratory rate with decreased tidal volume, leading to rising PaCO2 levels.
A researcher is investigating the effects of septic shock on cellular metabolism. Which of the following observations would provide the STRONGEST evidence for impaired mitochondrial function as a key component of septic shock-induced multi-organ dysfunction?
A researcher is investigating the effects of septic shock on cellular metabolism. Which of the following observations would provide the STRONGEST evidence for impaired mitochondrial function as a key component of septic shock-induced multi-organ dysfunction?
- Increased levels of lactate dehydrogenase (LDH) in serum, indicating widespread cellular necrosis.
- Decreased oxygen consumption by isolated mitochondria from liver tissue, coupled with increased production of reactive oxygen species (ROS). (correct)
- Increased expression of heat shock proteins (HSPs) in renal tubular cells, indicating cellular stress.
- Elevated levels of serum ketones, suggesting a shift towards fatty acid metabolism.
A previously healthy 25-year-old male develops a severe systemic infection secondary to Streptococcus pyogenes, leading to septic shock. Which of the following immunological phenomena would be MOST directly implicated in the pathogenesis of the widespread vasodilation characteristic of this condition?
A previously healthy 25-year-old male develops a severe systemic infection secondary to Streptococcus pyogenes, leading to septic shock. Which of the following immunological phenomena would be MOST directly implicated in the pathogenesis of the widespread vasodilation characteristic of this condition?
In comparing hypovolemic shock with anaphylactic shock, which of the following statements BEST differentiates the underlying mechanisms leading to decreased effective circulating volume?
In comparing hypovolemic shock with anaphylactic shock, which of the following statements BEST differentiates the underlying mechanisms leading to decreased effective circulating volume?
Flashcards
Hemorrhage
Hemorrhage
Escape of blood outside the blood vessels or heart.
External Hemorrhage
External Hemorrhage
Blood escapes outside the body. Examples: bleeding from skin wounds and vomiting of blood.
Internal Hemorrhage
Internal Hemorrhage
Blood accumulates in serous cavities like the pleura or pericardium.
Interstitial Hemorrhage
Interstitial Hemorrhage
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Circulatory Shock
Circulatory Shock
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Study Notes
- Hemorrhage is defined as the escape of blood outside the blood vessels or heart
Causes of Hemorrhage
- Rupture of an artery or vein can occur due to:
- Laceration of a normal vessel from trauma or a tumor
- Laceration of a diseased vessel due to hypertension or atheroma
- Systemic diseases such as leukemia
- Bacterial infections like septicemia
- Capillary bleeding results from minor trauma
Classification of Hemorrhage
External Hemorrhage
- Blood escapes outside the body
- Types of external hemorrhage include:
- Bleeding from skin wounds
- Epistaxis (bleeding from the nose)
- Hemoptysis (coughing of blood)
- Hematemesis (vomiting of blood)
- Melena (digested blood in stool)
- Bleeding/rectum (fresh blood in stool)
- Hematuria (blood in urine)
Internal Hemorrhage
- Blood accumulates in serous cavities
- Types of internal hemorrhage:
- Hemothorax (accumulation of blood in the pleura)
- Hemopericardium (accumulation of blood in the pericardium)
- Hemoperitoneum (accumulation of blood in the peritoneum)
- Hemoarthrosis (accumulation of blood in a joint space)
Interstitial Hemorrhage
- Blood escapes into the tissue spaces
- Types of interstitial hemorrhage:
- Petechial hemorrhage: pin-head sized
- Purpura: tiny bleeding area, greater than 3 mm in diameter
- Ecchymoses (bruise): discoloration of skin with large, irregular hemorrhagic areas larger than 1 cm
- Hematoma: a large amount of blood causing swelling
Effect of Hemorrhage
- The effect of hemorrhage depends on:
- Volume of blood loss
- Rate of blood loss
- Site of bleeding
Blood Volume Loss and Effects
- Small amount of blood loss (≤10% of blood volume):
- Has almost no effect
- Repeated loss can lead to iron deficiency anemia
- Moderate amount of blood loss (15% of blood volume):
- Leads to decreased blood volume
- Decreases venous return
- Decreases cardiac output (COP)
- Decreases blood pressure
- Massive amount of blood loss (>25% of blood volume):
- Can result in hypovolemic shock and death
Circulatory Shock
- Defined as inadequate blood and oxygen perfusion to tissues and cells
- Usually due to a sudden, severe drop in cardiac output or blood volume
Types of Shock
- Neurogenic
- Hypovolemic
- Cardiogenic
- Anaphylactic
- Septic
Stages of Shock
Non-Progressive (Compensated) Stage
- Includes compensatory mechanisms:
- Increased heart rate
- Increased respiratory rate
- Vasoconstriction of all blood vessels except those of the heart and CNS (to maintain blood flow to vital organs)
Progressive (Decompensated) Stage
- Failure of compensatory mechanisms to maintain adequate perfusion to the brain and vital organs
Irreversible (Terminal) Stage
- The point of no return due to rapid deterioration of the cardiovascular system
Commonality Among Types of Shock
- Decreased cardiac output (COP) leads to decreased tissue perfusion in all types of shock
Specific Types of Shock
Neurogenic Shock
- Caused by a factor that:
- Stimulates parasympathetic activity, leading to decreased heart rate and cardiac output
- OR inhibits sympathetic effect on vascular smooth muscle, causing loss of vascular tone, widespread vasodilation, and decreased effective blood volume
Hypovolemic Shock
- Caused by factors that induce severe blood or fluid loss:
- Decreased blood volume
- Decreased venous return (VR)
- Decreased cardiac output (COP)
- Decreased tissue perfusion
Cardiogenic Shock
- The heart suddenly can't pump enough blood to meet the body's needs due to:
- Failure of the myocardial pump
- Obstruction to outflow of blood
- Leading to reduced cardiac output (COP)
Anaphylactic Shock
- Results from a severe allergic reaction:
- Allergy to food, insect bites, or certain medications
- Systemic vasodilation and increased vascular permeability occur, decreasing effective blood volume
Septic Shock
- Characterized by bacterial toxins, leading to:
- Vasodilation (VD) by chemical mediators, decreasing effective blood volume
- Endothelial damage by toxins, causing disseminated intravascular coagulation (DIC)
- Toxic cell injury of organs
Causes of Specific Types of Shock
- Spinal cord injury: Cause of Neurogenic shock
- Blood loss in hemorrhage or fluid loss: Cause of Hypovolemic shock
- Myocardial infarction, cardiac surgery, or pulmonary embolism: Cause of Cardiogenic shock
- Immunoglobulin E-mediated hypersensitivity reaction: Cause of Anaphylactic shock
- Severe bacterial infections and septicemia: Cause of Septic shock:
- Gram-negative organisms like E. coli
- Gram-positive organisms like meningococci, infected burns and immunodeficiency states
Effects of Septic Shock
- Multi-organ dysfunction and failure, affecting kidneys, liver, lungs, and heart
- Metabolic abnormalities include hyperglycemia due to insulin resistance and altered lipid metabolism
- Immune suppression occurs due to the production of anti-inflammatory mediators
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