Signs of Shock Quiz

Essential Medications for Paramedics

• Analgesic medications relieve pain without causing unconsciousness, with examples including morphine sulfate (powerful relief from moderate to severe pain with sedating effects) and fentanyl citrate (faster-acting alternative with higher potency).
• Antiemetic medications prevent nausea and vomiting, with examples including promethazine (Phenergan, used for motion sickness, postoperative nausea, or chemotherapy-related emesis, but with side effects like drowsiness) and dexamethasone (quick relief from acute nausea).
• Anticholinergic medications are used by paramedics, with examples including atropine (treats bradycardia caused by overdoses or other underlying issues) and glycopyrrolate (safer alternative for cases where heart rhythm isn't affected).
• Bronchodilator medications relax smooth muscle tissue lining airways, allowing them to dilate and improve breathing, with examples including salbutamol (quick treatment of asthma exacerbations) and ipratropium bromide (provides prolonged action for patients who continue to experience wheezing).
• Vasopressor medications raise blood pressure levels by increasing peripheral vascular resistance, with examples including ephedrine (less frequently used due to risks associated with excessive catecholamine release), phenylephrine, and norepinephrine (primary options for treating shock states).

The Extrinsic Pathway

• The extrinsic pathway initiates hemostasis outside blood vessels due to tissue disruption, involving the interaction between tissue factors (TF) and circulating VII (tissue factor pathway inhibitor-dependent) or IX and X (tissue factor pathway inhibitor-independent).
• Tissue factor binds with its specific receptor, factor VII, forming a TF-VIIa complex, which activates factors X and IX, leading to prothrombin conversion to thrombin.

Understanding Clotting Cascades

• The human body relies on two interconnected mechanisms, the intrinsic and extrinsic pathways of blood coagulation, to prevent excessive bleeding while maintaining proper circulation.
• The intrinsic pathway is initiated through contact with negatively charged surfaces, primarily contributing to coagulation after vascular injury.
• The extrinsic pathway starts with the exposure of blood to tissue factor released by injured cells.

The Intrinsic Pathway

• The intrinsic pathway involves the interaction between factor XII, prekallikrein, high molecular weight kininogen, and endothelial cell surface receptors known as thrombomodulin.
• Factor XII gets activated, converting prekallikrein into kallikrein, which activates factor XI, leading to the activation of factor IX and subsequent protein conversions.

The Common Pathway

• The common pathway is the final phase where the intrinsic and extrinsic pathways merge, involving the formation of the prothrombinase complex, which catalyzes the transformation of prothrombin to thrombin.
• Thrombin catalyzes the production of fibrin strands, ultimately forming a stable clot.

Coagulation Factors

• There are twelve coagulation factors participating in the clotting cascade, each playing specific roles in generating or inhibiting clots.
• Factors serve as precursors of enzymes required for clot initiation or help control thrombin activity or prevent abnormal clot growth.

Fibrinolysis

• Fibrinolysis is the process of dissolving excess clots via the action of plasmin, which breaks down cross-linked fibrin strands back to their original constituents.
• Plasminogens convert to active plasmins through a series of activators such as tPA (tissue plasminogen activator) and urokinase-type plasminogen activator (uPA).

Understanding Inflammation

• Inflammation is a complex biological process serving as one of the body's primary defense mechanisms against disease, infection, injury, and cellular dysfunction.
• The inflammatory response involves multiple signaling cascades within cells, classified into innate immunity pathways and adaptive immunity pathways.

Inflammation Pathways

• Innate immunity pathways represent a frontline defense mechanism activated by macrophages, neutrophils, dendritic cells, and natural killer cells upon encountering foreign invaders.
• Adaptive immunity pathways lead to highly specific responses tailored to target particular antigens once introduced to the body.

Acute Inflammation

• Acute inflammation is a rapid localized reaction lasting hours to days following tissue injury or infection, characterized by redness, warmth, swelling, and pain.
• Cells lining blood vessels release chemical signals called vasoactive amines, increasing capillary permeability and attracting leukocytes, leading to fluid accumulation around injured areas.

Cytokines

• Cytokines are critical messengers within the inflammatory response, regulating and coordinating various aspects of immune function.
• They exist in both pro-inflammatory and anti-inflammatory forms, allowing for dynamic control over the extent and duration of inflammation.
• Key examples of cytokines associated with acute inflammation include tumor necrosis factor alpha (TNF-α), interleukin-1 beta (IL-1β), IL-6, and IL-8.