Podcast
Questions and Answers
Which of the following organisms is NOT associated with the pathophysiology of septic shock?
Which of the following organisms is NOT associated with the pathophysiology of septic shock?
- Klebsiella
- Proteus
- Escherichia coli
- Staphylococcus aureus (correct)
What is the initial stage of septic shock characterized by?
What is the initial stage of septic shock characterized by?
- Loss of pyrogenic response and decompensated shock
- Disseminated intravascular coagulation (DIC) and hypodynamic state
- Severe circulatory failure and multiple organ dysfunction syndrome (MODS)
- Fever, tachycardia, and tachypnea (correct)
Which of the following processes is NOT involved in the pathophysiology of septic shock?
Which of the following processes is NOT involved in the pathophysiology of septic shock?
- Activation of macrophages, neutrophils, and monocytes
- Release of cytokines and free radicals leading to endothelial injury
- Upregulation of angiotensin-converting enzyme (ACE) activity (correct)
- Inflammation and chemotaxis of cells
What is the primary cause of severe hypotension in the early stage of septic shock?
What is the primary cause of severe hypotension in the early stage of septic shock?
Which stage of septic shock is considered reversible?
Which stage of septic shock is considered reversible?
What is the primary cause of multiple organ dysfunction syndrome (MODS) in septic shock?
What is the primary cause of multiple organ dysfunction syndrome (MODS) in septic shock?
What is the irreversible stage in shock characterized by anuria, respiratory failure, jaundice, and eventually coma and death?
What is the irreversible stage in shock characterized by anuria, respiratory failure, jaundice, and eventually coma and death?
What can happen in unresuscitatable shock due to prolonged profound shock?
What can happen in unresuscitatable shock due to prolonged profound shock?
What is the name of the syndrome where further injury occurs once normal circulation is restored to tissues following a period of systemic hypoperfusion?
What is the name of the syndrome where further injury occurs once normal circulation is restored to tissues following a period of systemic hypoperfusion?
In Ischaemia–reperfusion syndrome, what can lead to direct myocardial depression and vascular dilatation?
In Ischaemia–reperfusion syndrome, what can lead to direct myocardial depression and vascular dilatation?
Which of the following is NOT a complication of poor shock management as discussed in the text?
Which of the following is NOT a complication of poor shock management as discussed in the text?
What results from unresuscitatable shock as per the text?
What results from unresuscitatable shock as per the text?
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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
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