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Questions and Answers
What is the primary molecule used for energy storage in cells?
What is the primary molecule used for energy storage in cells?
What must occur for oxygen to effectively reach the circulation?
What must occur for oxygen to effectively reach the circulation?
What is the effect of inadequate energy production on cellular functions?
What is the effect of inadequate energy production on cellular functions?
Which component is responsible for distributing red blood cells throughout the body?
Which component is responsible for distributing red blood cells throughout the body?
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What is the consequence of not maintaining a patent airway?
What is the consequence of not maintaining a patent airway?
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What is necessary for cellular function to maintain adequate energy production?
What is necessary for cellular function to maintain adequate energy production?
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What is the consequence of an interruption in the oxygen supply?
What is the consequence of an interruption in the oxygen supply?
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What key factor improves survival rates for traumatic injury victims?
What key factor improves survival rates for traumatic injury victims?
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What leads to the condition known as shock?
What leads to the condition known as shock?
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Which condition is NOT necessary for a continuous and adequate oxygen supply?
Which condition is NOT necessary for a continuous and adequate oxygen supply?
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What is the most common cause of hypoperfusion after trauma?
What is the most common cause of hypoperfusion after trauma?
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In class II hemorrhagic shock, what is the expected pulse rate?
In class II hemorrhagic shock, what is the expected pulse rate?
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What occurs in the ischemic phase of shock?
What occurs in the ischemic phase of shock?
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What happens to stroke volume if blood volume decreases?
What happens to stroke volume if blood volume decreases?
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Which of the following closely relates to maintaining blood pressure?
Which of the following closely relates to maintaining blood pressure?
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What is a key characteristic of neurogenic shock?
What is a key characteristic of neurogenic shock?
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In class III hemorrhagic shock, how does the mental status of a patient typically present?
In class III hemorrhagic shock, how does the mental status of a patient typically present?
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What type of shock is associated with pericardial tamponade?
What type of shock is associated with pericardial tamponade?
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Which organ systems are considered extremely sensitive to hypoperfusion?
Which organ systems are considered extremely sensitive to hypoperfusion?
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What occurs when cardiac output falls during shock?
What occurs when cardiac output falls during shock?
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What is a common result of prolonged shock in the hepatic system?
What is a common result of prolonged shock in the hepatic system?
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How long can organs tolerate hypoperfusion before dysfunction occurs?
How long can organs tolerate hypoperfusion before dysfunction occurs?
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Which type of shock results from an interruption of the sympathetic nervous system?
Which type of shock results from an interruption of the sympathetic nervous system?
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In class I hemorrhagic shock, what is the state of blood pressure?
In class I hemorrhagic shock, what is the state of blood pressure?
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What initiates inhalation during normal breathing?
What initiates inhalation during normal breathing?
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What is the main function of hemoglobin in red blood cells?
What is the main function of hemoglobin in red blood cells?
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What is a significant by-product of aerobic metabolism?
What is a significant by-product of aerobic metabolism?
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Which factor is essential for aerobic metabolism to occur?
Which factor is essential for aerobic metabolism to occur?
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What happens to energy production when the body transitions to anaerobic metabolism?
What happens to energy production when the body transitions to anaerobic metabolism?
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Which condition is a consequence of hypoperfusion?
Which condition is a consequence of hypoperfusion?
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What type of metabolism is primarily used during short bursts of intense exercise?
What type of metabolism is primarily used during short bursts of intense exercise?
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What is a potential effect of lactic acid buildup in cells?
What is a potential effect of lactic acid buildup in cells?
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What physiological state is characterized by a lack of adequate oxygen supply to cells?
What physiological state is characterized by a lack of adequate oxygen supply to cells?
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What type of shock is caused by significant blood loss?
What type of shock is caused by significant blood loss?
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What can excessive hydration in a hypoperfusion state lead to?
What can excessive hydration in a hypoperfusion state lead to?
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Which process is impaired as body temperature drops due to shock?
Which process is impaired as body temperature drops due to shock?
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What is the primary fuel source for anaerobic metabolism?
What is the primary fuel source for anaerobic metabolism?
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What leads to the continuation of cellular dysfunction in a state of hypoperfusion?
What leads to the continuation of cellular dysfunction in a state of hypoperfusion?
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Study Notes
Introduction to Trauma - Physiology of Life & Death
- Body systems are interconnected and interdependent
- Every cell and organ work together to sustain cellular energy production and maintain vital metabolic processes
- Energy powers all body functions and sustains cellular and organ functions
- Cells create energy from oxygen and glucose, storing it as ATP (adenosine triphosphate) molecules
- Without energy, cellular functions cease
- The goal is to maintain the patient's body energy production
Systems & Components - Airway
- The airway must be patent (open)
- Breathing (lungs) must supply adequate oxygen:
- Oxygen reaches the alveoli
- Oxygen crosses the alveolar/capillary wall
- Oxygen enters the circulation
- Carbon dioxide (CO2) must be removed
Systems & Components - Circulation
- Circulation distributes red blood cells (RBCs)
- Circulation ensures adequate numbers of RBCs
- Circulation transports oxygen to every cell in every organ
- Oxygen is then off-loaded to fuel the metabolic processes of the cell
- CO2 is transferred from the cells to the plasma for removal by the lungs
Key Components for Energy Production
- Glucose and oxygen are required for energy production
Airway
- An open airway is critical for delivering air (oxygen) to the alveoli
- Normal air movement is from negative intrathoracic pressure as the chest expands, filling the alveoli with air.
- Exhalation results from increased intrathoracic pressure as the chest relaxes, forcing air out of the alveoli
Breathing
- When air reaches the alveoli, oxygen crosses the alveolar-capillary membrane
- Oxygen enters the red blood cells (RBCs)
- Oxygen attaches to hemoglobin for transport
- CO2 in the plasma and cells is a byproduct of aerobic metabolism and energy production
- CO2 crosses the alveolar-capillary membrane into the alveoli
- CO2 is removed during exhalation
Circulation
- Oxygen-enriched RBCs are pumped through the body to deliver oxygen to target organs
- Oxygen is off-loaded from RBCs to fuel cell metabolic processes
- CO2 is transferred from cells to the plasma for elimination through the lungs
Aerobic Metabolism
- Aerobic metabolism is the most efficient method of energy production
- It uses oxygen and glucose with chemical reactions (glycolysis and the Krebs cycle) to produce large amounts of energy
- Waste products are carbon dioxide and water
Aerobic Metabolism is Dependent Upon
- Adequate and continuous supply of oxygen
- A patent airway
- Functioning lungs
- Functional heart
- Intact vascular system
- Adequate supply of RBCs
Anaerobic Metabolism
- Anaerobic metabolism is a metabolic process that functions in the absence of oxygen
- It uses stored glucose (glycogen) for energy production
- It is capable of sustaining only short-term energy requirements
- It produces much less energy than aerobic metabolism (approximately 19-fold decrease)
- Increased lactic acid is a by-product
Shock
- Inadequate energy production required to sustain life
- Results from changing from aerobic to anaerobic metabolism
- Secondary to hypoperfusion (inadequate blood flow)
- Delivery of oxygen is insufficient to meet metabolic demands
- Decreased energy production leads to cellular and organ death
Consequences of Hypoperfusion
- Cellular hypoxia
- Decreased ATP (energy) production
- Cell dysfunction
- Lactic acid buildup
- Low pH
- Cell autodigestion
- Cellular edema
- Further loss of blood volume
- Cycle continues
Consequences of Hypoperfusion (continued)
- Inadequate ATP causes cells and organs to not function properly
- Hypothermia (decreased heat production)
- Acidosis (increased lactic acid production)
- Coagulopathy (impaired blood clotting)
Triangle of Death
- Acidosis, loss of energy, hypothermia, and coagulopathy are involved in the death cascade
Cascade of Death
- Anaerobic metabolism
- Decreased energy production
- Cellular death
- Organ death
- Patient death
Types of Shock
- Hypovolemic
- Dehydration
- Burns
- Hemorrhage
- Distributive
- Neurogenic
- Septic
- Anaphylactic
- Psychogenic
- Cardiogenic
- Pump failure (intrinsic/extrinsic)
Hemorrhagic Shock
- Most common cause of hypoperfusion after trauma (internal or external blood loss)
Pathophysiology of Shock
- Shock is progressive
- Changes in shock include:
- Hemodynamic
- Cellular (metabolic)
- Microvascular
- Compensatory mechanisms (short-term)
- Compensatory mechanisms will fail without interventions
Pathophysiology of Shock (continued)
- Heart must be an effective pump
- Heart is primed by return of blood through the vena cava
- Starling's Law
- Stroke volume (SV) is the amount of blood ejected with each contraction
- Blood volume decrease leads to SV decrease
- Cardiac output (CO) decreases unless heart rate increases
- Adequate blood pressure is required to maintain cellular perfusion
- CO is a factor in maintaining blood pressure (BP)
- If CO falls, vasoconstriction occurs
- Systemic vascular resistance (SVR) increases
- Vasoconstriction leads to the ischemic phase of shock
- Early precapillary and postcapillary sphincters constrict
- Tissues become ischemic and are forced to produce energy anaerobically
- As acidosis increases, precapillary sphincters relax while postcapillary sphincters remain constricted
- Results in stagnation of blood in the capillary bed and washout, releasing micro-emboli
- Aggravates acidosis
- Causes infarction of organs by micro-emboli
Neurogenic Shock
- Associated with spinal cord injury
- Interruption of sympathetic nervous system leading to vasodilation
- Patient has normal blood volume but vascular container is enlarged, thus decreasing blood pressure
Cardiogenic Shock
- Results from external compression of the heart
- Ventricles cannot fully expand
- Less blood is ejected with each contraction
- Blood return to the heart is decreased
- Causes from trauma include:
- Pericardial tamponade
- Tension pneumothorax
Signs Associated with Shock Types
- Hypovolemic
- Neurgenic
- Cardiogenic
Organ Sensitivity to Hypoperfusion
- Extremely sensitive: brain, heart, lungs (minutes)
- Moderately sensitive: kidneys, liver, gastrointestinal tract (1-1.5 hours)
- Least sensitive: muscle, bone, skin (4-6 hours)
Organ System Failure
- If not recognized and promptly corrected, shock leads to organ dysfunction
- First in oxygen-sensitive organs
- Followed by other, less oxygen sensitive organs
- Cascading effect results in multi-organ dysfunction syndrome and patient death
- Failure of one major organ system results in approximately 40% mortality
- Additional organ system failure leads to mortality approaching 100%
- Acute renal failure: Results if oxygen delivery is impaired for more than 45-60 minutes
- Decreased renal output -> Reduced clearing of toxic products
- Acute respiratory distress syndrome (ARDS): damage to alveolar cells, hyper-resuscitation (fluid overload)
- Fluid leakage into interstitial spaces and alveoli
- Hematologic failure: impaired clotting cascade, hypothermia, dilution or depletion of clotting factors
- Hepatic failure: Results from prolonged shock, overwhelming infection, and decreased functioning of the immune system due to ischemia and energy production loss
Summary for Compensated Hemorrhagic Shock
- Sinus tachycardia, tachypnea, normal systolic, narrowed pulse pressure, mild anxiety, cool and pale skin
General Summary
- Cellular function depends on adequate energy production, which depends on a continuous supply of oxygen.
- Impaired oxygen supply leads to anaerobic metabolism
- Inadequate energy production for sustained cellular function results in cellular dysfunction, cell death, organ dysfunction, and eventually, patient death.
- Early recognition and prompt intervention are crucial for improving survival rates in traumatic injury victims.
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Description
This quiz covers essential concepts in human physiology related to energy storage, oxygen circulation, and the physiological responses to shock. Test your knowledge on critical factors that influence cellular functions and survival rates during traumatic injuries. Each question aims to deepen your understanding of how the body maintains homeostasis under stress.
