12 Questions
Which of the following organisms is NOT associated with the pathophysiology of septic shock?
Staphylococcus aureus
What is the initial stage of septic shock characterized by?
Fever, tachycardia, and tachypnea
Which of the following processes is NOT involved in the pathophysiology of septic shock?
Upregulation of angiotensin-converting enzyme (ACE) activity
What is the primary cause of severe hypotension in the early stage of septic shock?
Sustained release of high levels of nitric oxide causing peripheral vasodilation
Which stage of septic shock is considered reversible?
Hyperdynamic (warm) shock
What is the primary cause of multiple organ dysfunction syndrome (MODS) in septic shock?
Severe circulatory failure due to hypotension
What is the irreversible stage in shock characterized by anuria, respiratory failure, jaundice, and eventually coma and death?
Irreversible stage
What can happen in unresuscitatable shock due to prolonged profound shock?
Loss of responsiveness to fluid or inotropic therapy
What is the name of the syndrome where further injury occurs once normal circulation is restored to tissues following a period of systemic hypoperfusion?
Ischaemia–reperfusion syndrome
In Ischaemia–reperfusion syndrome, what can lead to direct myocardial depression and vascular dilatation?
Flushed back cellular and humoral elements
Which of the following is NOT a complication of poor shock management as discussed in the text?
Cardiac recovery
What results from unresuscitatable shock as per the text?
Further hypotension due to loss of systemic vascular resistance ability
Study Notes
Classification of Hemorrhage
- Based on the source of bleeding:
- Arterial: bright red in color, spurting like a jet along with pulse of the patient
- Venous: dark red, steady and continuous flow
- Capillary: rapid and bright red, often torrential due to continuous ooze
- Based on the time of onset of bleeding in relation to trauma:
- Primary: occurs at the time of injury or operation
- Reactionary: occurs within 24 hours after surgery or after injury
- Secondary: occurs in 7-14 days after surgery
Pathophysiology of Hemorrhage
- Bleeding leading to:
- Circulatory hypovolaemia
- Cellular hypoxia
- Coagulopathy
- Circulatory hypovolaemia:
- Low cardiac output
- Tachycardia and shunting of blood from splanchnic vessels by vasoconstriction
- Cellular hypoxia:
- Anaerobic metabolism and altered cell membrane function
- Influx of sodium and calcium inside the cell and potassium comes out of the cell
- Hyponatraemic, hypocalcaemic, hyperkalaemic metabolic acidosis
- Coagulopathy:
- Consumption coagulopathy
- Dilution coagulopathy
- Acidosis induced coagulopathy
- Hypothermia induced coagulopathy
- Inflammatory factors induced coagulopathy
- Genetic effect in induction of coagulopathy
Measurement of Blood Loss
- The adult human has approximately 5 liters of blood
- Methods of measurement:
- Collection in suction bottles inside theater
- Clot size of a clenched fist is 500 ml
- Blood loss in a closed spaced tibial fracture is 500-1500 ml
- Weighing the swab before and after use
- Hb% and PCV estimation
- Blood volume estimation using radioiodine technique or micro-haematocrit method
- Measurement of CVP or PCWP
Treatment of Bleeding
- Identify hemorrhage: external hemorrhage may be obvious, but the diagnosis of concealed hemorrhage may be more difficult
- Any shock should be assumed to be hypovolaemic until proved otherwise
Test your knowledge of surgical history, principles, and procedures with this introductory quiz. Designed by Dr. Ali Jawad Al-Shammari from the College of Medicine at the University of Al-Qadissiyah, this quiz covers the basics of surgery and its role in diagnosing and managing injuries, defects, and deformities. Challenge yourself and expand your surgical knowledge today!
Make Your Own Quizzes and Flashcards
Convert your notes into interactive study material.
Get started for free
