Types of Shock and Multi-System Dysfunction

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Questions and Answers

What condition is characterized by sepsis with profound hypotension and perfusion abnormalities despite resuscitation?

  • Multi-Organ Dysfunction Syndrome (MODS)
  • Septic Shock (correct)
  • Anaphylactic Shock
  • Systemic Inflammation Response Syndrome (SIRS)

Which physiological change is likely to occur in the body during the systemic inflammatory response associated with sepsis?

  • Improved tissue perfusion
  • Increased temperature (correct)
  • Increased systemic vascular resistance (SVR)
  • Decreased heart rate

Which of the following symptoms is typically observed in a patient with septic shock?

  • Hypotension (correct)
  • Bradycardia
  • Hypoglycemia
  • Hypertension

Which process impairs the ability of the body to break down clots during sepsis, contributing to decreased tissue perfusion?

<p>Impaired fibrinolysis (B)</p> Signup and view all the answers

What major effect does Multi-Organ Dysfunction Syndrome (MODS) have on the body?

<p>Multi-system organ failure (A)</p> Signup and view all the answers

Which type of shock is primarily characterized by insufficient blood volume within the vascular space leading to hypoxia?

<p>Hypovolemic shock (A)</p> Signup and view all the answers

In which stage of shock is the blood pressure still normal but the heart rate may be elevated?

<p>Compensatory stage (A)</p> Signup and view all the answers

What is a common physiological response in the body during the compensatory mechanisms of shock?

<p>Increased sodium and water retention (A)</p> Signup and view all the answers

What is a key indicator of inadequate tissue perfusion?

<p>Cellular hypoxia (D)</p> Signup and view all the answers

Which type of shock is characterized by the heart's inability to pump sufficient blood to tissues?

<p>Cardiogenic shock (A)</p> Signup and view all the answers

What is a common clinical manifestation of septic shock?

<p>Hypotension that requires vasopressors (B)</p> Signup and view all the answers

Which of the following is NOT a potential cause of cardiogenic shock?

<p>Fluid loss from burns (C)</p> Signup and view all the answers

What does increased microvascular permeability during an inflammatory response lead to?

<p>Increased nutrient delivery (A)</p> Signup and view all the answers

Which feature characterizes multi-organ dysfunction syndrome (MODS) in the context of shock?

<p>Progression from initial compensatory mechanisms (C)</p> Signup and view all the answers

What is meant by 'anaerobic metabolism' in the context of shock?

<p>Energy production without oxygen resulting in lactic acid accumulation (C)</p> Signup and view all the answers

In which type of shock would you expect to see significant skin mottling?

<p>Septic shock (D)</p> Signup and view all the answers

During shock, what occurs as a result of cellular destruction and metabolic waste accumulation?

<p>Decreased ATP production (C)</p> Signup and view all the answers

What is a hallmark of distributive shock?

<p>Vasodilation and maldistribution of blood volume (A)</p> Signup and view all the answers

What critical sign often accompanies decreased urine output in shock?

<p>Decreased blood pressure (A)</p> Signup and view all the answers

What characterizes the progressive process of Multiple Organ Dysfunction Syndrome (MODS)?

<p>Failure of two or more organ systems after severe illness or injury (C)</p> Signup and view all the answers

Which physiological response is triggered in hypovolemic shock to compensate for decreased blood volume?

<p>Constriction of arterioles and veins (D)</p> Signup and view all the answers

What is a primary clinical manifestation of compensated shock?

<p>Unexplained tachycardia (B)</p> Signup and view all the answers

Which mechanism contributes to impaired tissue perfusion during shock?

<p>Altered peripheral vascular resistance (A)</p> Signup and view all the answers

What does the term 'hyperdynamic state' refer to in the context of MODS?

<p>Increased metabolic and cardiovascular activity (C)</p> Signup and view all the answers

Which of the following is NOT a consequence of shock?

<p>Increased urinary output (C)</p> Signup and view all the answers

In pediatric patients, which sign indicates decompensated shock?

<p>Oliguria (B)</p> Signup and view all the answers

What role does the renin-angiotensin system play in shock states?

<p>It helps conserve blood volume. (D)</p> Signup and view all the answers

Which of the following is a sign of irreversible shock?

<p>Thready, weak pulse (B)</p> Signup and view all the answers

In the context of COVID-19, which receptor is primarily involved in the entry of the virus into host cells?

<p>ACE2 (B)</p> Signup and view all the answers

Which symptom is commonly associated with the multisystem inflammatory disease observed in children after COVID-19?

<p>Skin rash (D)</p> Signup and view all the answers

What are the consequences of cerebral edema associated with hypovolemic shock?

<p>Increased intracranial pressure (B)</p> Signup and view all the answers

What is a classic early sign of anaphylaxis?

<p>Flushing and urticaria (B)</p> Signup and view all the answers

Which clinical manifestation indicates that shock has progressed to the irreversible stage?

<p>Cool, pale extremities (B)</p> Signup and view all the answers

Which potent vasodilator is released by mast cells during an antigen-antibody reaction?

<p>Histamine (C)</p> Signup and view all the answers

Which of the following allergens is NOT typically associated with anaphylaxis?

<p>Toxic Plants (A)</p> Signup and view all the answers

What is a characteristic clinical manifestation of anaphylaxis?

<p>Wheezing (D)</p> Signup and view all the answers

What physiological change occurs as a result of distributive neurogenic shock?

<p>Vasodilation (D)</p> Signup and view all the answers

Which of the following symptoms is part of the clinical presentation of anaphylaxis?

<p>Feeling of a 'lump in the throat' (A)</p> Signup and view all the answers

What is a primary consequence of systemic inflammation during the sepsis continuum?

<p>Coagulation disruption in the microvasculature (C)</p> Signup and view all the answers

Which of the following is a common source of sepsis that affects the integumentary system?

<p>Necrotizing fasciitis (B)</p> Signup and view all the answers

What cardiovascular condition is characteristic of a patient experiencing septic shock?

<p>Tachycardia with decreased systemic vascular resistance (C)</p> Signup and view all the answers

Which of the following complications is associated with the impaired ability to dissolve clots during sepsis?

<p>Thrombocytopenia (C)</p> Signup and view all the answers

What systemic effect results from a severe allergic reaction leading to anaphylactic shock?

<p>Vascular leakage and vasodilation (B)</p> Signup and view all the answers

What characterizes the early stage of sepsis?

<p>Vasodilation with increased cardiac output (B)</p> Signup and view all the answers

Which type of shock is associated with blood vessel problems?

<p>Distributive shock (A)</p> Signup and view all the answers

What happens to the kidneys during metabolic acidosis?

<p>They retain more hydrogen ions and reduce urine output (D)</p> Signup and view all the answers

What is the primary cause of respiratory acidosis?

<p>Hypoventilation leading to CO2 retention (C)</p> Signup and view all the answers

In the context of acid-base balance, what do buffer systems primarily do?

<p>React to changes in acid-base status to maintain pH balance (B)</p> Signup and view all the answers

During respiratory alkalosis, what would you expect to be true about the carbon dioxide levels?

<p>They are low due to excessive ventilation (B)</p> Signup and view all the answers

Which physiological response indicates an attempt to compensate for pH changes during acidosis?

<p>Increased ventilation to expel CO2 (D)</p> Signup and view all the answers

What is the typical arterial pH range considered normal?

<p>7.35 - 7.45 (C)</p> Signup and view all the answers

What systemic response begins with an infection that can be difficult to locate?

<p>Septic Shock (D)</p> Signup and view all the answers

What physiological mechanism contributes to the decrease in stroke volume during hypovolemic shock?

<p>Decreased cardiac output (A)</p> Signup and view all the answers

Which clinical manifestation is most indicative of cardiogenic shock?

<p>Cold, clammy skin (D)</p> Signup and view all the answers

What results from the impairment of oxygen use at the cellular level in shock?

<p>Anaerobic metabolism (B)</p> Signup and view all the answers

Which condition can trigger cardiogenic shock due to obstruction?

<p>Pulmonary embolism (D)</p> Signup and view all the answers

What is a potential consequence of untreated shock?

<p>Multi-Organ Dysfunction Syndrome (MODS) (D)</p> Signup and view all the answers

What is the primary cause of metabolic acidosis during cellular hypoxia?

<p>Lactic acid accumulation (C)</p> Signup and view all the answers

Which compensatory mechanism occurs during hypovolemic shock?

<p>Release of aldosterone (B)</p> Signup and view all the answers

What is a classic objective sign of progressive shock?

<p>Erratic or asystolic blood pressure (A)</p> Signup and view all the answers

What does increased venous capacitance result in during distributive shock?

<p>Decreased venous return (A)</p> Signup and view all the answers

Which symptom is associated with systemic inflammatory response syndrome (SIRS)?

<p>Fever (C)</p> Signup and view all the answers

What is a major characteristic of septic shock as defined in clinical terms?

<p>Persistently low blood pressure despite adequate volume resuscitation (B)</p> Signup and view all the answers

Which type of shock is specifically associated with an inability to utilize glucose effectively?

<p>Distributive shock (D)</p> Signup and view all the answers

What effect does the accumulation of toxic substances from bacteria have during septic shock?

<p>Activation of septic mediators (C)</p> Signup and view all the answers

What initiates and perpetuates Multi-Organ Dysfunction Syndrome (MODS)?

<p>Uncontrolled systemic inflammatory and stress responses (B)</p> Signup and view all the answers

Which symptom is commonly associated with the Multisystem Inflammatory Disease in children following COVID-19?

<p>Severe abdominal pain (B)</p> Signup and view all the answers

What physiological response occurs in hypovolemic shock?

<p>Increased peripheral vascular resistance (A)</p> Signup and view all the answers

What is a significant complication associated with hypovolemic shock?

<p>Cerebral edema (A)</p> Signup and view all the answers

Which of the following is a common clinical manifestation of compensated shock?

<p>Normal blood pressure (A)</p> Signup and view all the answers

What best characterizes the hypermetabolic state in Multiple Organ Dysfunction Syndrome (MODS)?

<p>Increased metabolic rate and stress response (C)</p> Signup and view all the answers

Which factor is correlated with the degree of shock in pediatric patients?

<p>Heart rate and perfusion to extremities (C)</p> Signup and view all the answers

How does COVID-19 primarily affect host cells to establish infection?

<p>By binding to the ACE2 receptor leading to membrane fusion (A)</p> Signup and view all the answers

Which of these is NOT a characteristic sign of irreversible shock?

<p>Confusion (C)</p> Signup and view all the answers

What condition is associated with symptoms such as flushing and urticaria following allergen exposure?

<p>Anaphylaxis (A)</p> Signup and view all the answers

Which complication may arise from the decreased tissue perfusion in shock states?

<p>Lactic acidosis (A)</p> Signup and view all the answers

In the context of shock, what is a primary physiological consequence of hypovolemia?

<p>Altered peripheral vascular resistance (A)</p> Signup and view all the answers

Which of the following is a hallmark feature of post-COVID-19 'Long Haulers' syndrome?

<p>Persistence of symptoms for weeks or months (D)</p> Signup and view all the answers

Which clinical manifestation commonly indicates decompensated shock?

<p>Cool, pale extremities (B)</p> Signup and view all the answers

Flashcards

Hypovolemic Shock

Shock caused by insufficient blood volume in the circulatory system, leading to decreased tissue perfusion.

Cardiogenic Shock

Shock caused by the heart's inability to pump enough blood to meet the body's needs.

Distributive Shock

Shock caused by widespread dilation of blood vessels, impairing blood flow to tissues.

Septic Shock

A type of distributive shock caused by a severe infection.

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Anaphylactic Shock

A type of distributive shock caused by a severe allergic reaction.

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Neurogenic Shock

A type of distributive shock caused by damage to the nervous system, leading to vasodilation.

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Multi-System Organ Failure (MODS)

A life-threatening condition where multiple organ systems fail due to severe illness or injury.

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Tissue Perfusion

Adequate blood flow to the tissues to maintain their function.

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Shock

A complex clinical syndrome causing cellular hypoxia, leading to organ and system failure.

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Compensatory Mechanisms (Shock)

The body's initial responses to shock, aimed at maintaining blood flow to vital organs.

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Progressive Shock

The worsening phase of shock, characterized by declining organ function.

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Irreversible Shock

The final stage of shock, where organ damage is so severe that recovery is impossible.

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Systemic Inflammatory Response Syndrome (SIRS)

A widespread inflammatory response throughout the body, often triggered by severe infection.

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Septic Shock Symptoms

Symptoms indicating widespread inflammation and poor blood circulation due to a severe infection

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Cardiogenic Shock Etiology

Causes of cardiogenic shock due to the heart's inability to effectively pump blood.

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Sepsis

A life-threatening condition caused by the body's overwhelming response to an infection.

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Multi-Organ Dysfunction Syndrome (MODS)

Failure of multiple organs in the body, often leading to death.

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Sepsis Sources (Common)

Urinary Tract Infections (UTIs), Pneumonia, and skin infections (like Necrotizing Fasciitis) are common causes of sepsis.

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MODS Definition

A severe condition where at least two organ systems fail after a serious illness or injury.

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MODS Trigger

Uncontrolled inflammatory and stress responses in the body.

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MODS Features

Hypermetabolic and hyperdynamic state, meaning increased metabolism and heart rate.

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COVID-19 Entry Point

SARS-CoV-2 enters the host cell through the ACE2 receptor, primarily found in the lungs.

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ACE2 Location

Present in lung, kidney, bladder, and small intestine cells.

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COVID-19 and RAS

The Renin-Angiotensin System (RAS) is significantly affected during COVID-19 infection.

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Long COVID Definition

Continued COVID-19 symptoms, weeks or months after recovery.

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Long COVID Triggers

Occurs after hospitalization, intensive care, or even mild infections.

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MIS-C Definition

A rare and severe condition affecting children with inflammation in multiple organs.

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MIS-C Symptoms

Fever, abdominal pain, vomiting, diarrhea, neck pain, rash, bloodshot eyes, and fatigue.

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Shock Definition

A critical condition where blood flow is inadequate, resulting in inadequate oxygen supply to the body.

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Shock Consequences

Hypotension (low blood pressure), tissue hypoxia (oxygen deficiency), and metabolic acidosis.

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Shock Causes

Hypovolemia (low blood volume), altered peripheral vascular resistance, or pump failure (heart problems).

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Shock Stages

Compensated - early, Decompensated - worsening, Irreversible - final, no recovery.

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Shock Differentiation

Key signs include tachycardia (fast heart rate), perfusion (blood flow to extremities), LOC (level of consciousness), and BP.

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MODS (Multi-Organ Dysfunction Syndrome)

A life-threatening condition where multiple organ systems fail due to an extreme inflammatory response, often triggered by sepsis.

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What are some common causes of sepsis?

Sepsis can arise from various infections, but common sources include urinary tract infections (UTIs), pneumonia, and skin infections like necrotizing fasciitis.

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What are the signs of someone with septic shock?

Septic shock often manifests as low blood pressure (hypotension), a rapid heart rate (tachycardia), fever, lactic acidosis, and changes in blood counts.

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Anaphylaxis Triggers

Anaphylaxis can be triggered by various allergens, including insect bites and stings, inhaled allergens like pollen and dust, skin contact with allergens like poison ivy, and food allergens like peanuts and shellfish.

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Anaphylaxis Symptoms

Anaphylaxis symptoms include difficulty breathing (dyspnea, wheezing), choking, throat tightness, skin reactions, nausea, dizziness, and a rapid heart rate.

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Neurogenic Shock Cause

Neurogenic shock is caused by a loss of sympathetic nervous system tone, which leads to widespread vasodilation. This can occur due to spinal cord injury, spinal anesthesia, or nervous system damage.

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Neurogenic Shock vs. Other Shocks

Neurogenic shock is unique because it often presents with bradycardia (slow heart rate), unlike other types of shock that typically feature tachycardia (fast heart rate).

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Mast Cell Release

An antigen-antibody reaction triggers mast cells to release potent vasodilators like histamine and bradykinin. This causes increased capillary permeability, leading to fluid leakage into surrounding tissues.

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What is Shock?

A critical state where the body's circulatory system fails to deliver adequate oxygen to tissues, leading to cellular damage and potential organ failure.

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Cellular Hypoxia

A lack of sufficient oxygen at the cellular level, leading to impaired energy production and cellular damage.

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Types of Shock

Different classifications of shock based on the underlying cause, including hypovolemic, cardiogenic, and distributive.

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Compensatory Mechanisms

The body's initial responses to shock, aiming to maintain blood flow to vital organs.

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SIRS (Systemic Inflammatory Response Syndrome)

A widespread inflammatory response throughout the body, often triggered by an infection.

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What is Sepsis?

A life-threatening condition caused by the body's overwhelming response to an infection, leading to organ dysfunction.

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Sepsis Stages

Sepsis progresses through distinct stages: early (hyperdynamic), normodynamic (decompensated), and late (hypodynamic). Each stage is characterized by specific symptoms and changes in vital signs.

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Hyperdynamic Sepsis

The initial stage of sepsis, marked by increased heart rate, fever, and vasodilation, leading to increased blood flow. The body is trying to fight the infection.

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Hypodynamic Sepsis

The late and most dangerous stage of sepsis, characterized by circulatory collapse, low blood pressure, weak pulses, and organ dysfunction.

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Acid/Base Imbalance

A disruption in the body's pH balance, either becoming too acidic (acidosis) or too alkaline (alkalosis). It affects many bodily functions and can be life-threatening.

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Metabolic Acidosis

A type of acid/base imbalance where the blood becomes too acidic due to an increase in metabolic acids or a loss of bicarbonate.

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Respiratory Acidosis

A type of acid/base imbalance where the blood becomes too acidic due to excessive carbon dioxide retention, often caused by poor lung function.

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Respiratory Alkalosis

A type of acid/base imbalance where the blood becomes too alkaline due to excessive loss of CO2, often caused by hyperventilation.

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Body Buffers

Substances in the body that help maintain a stable pH balance by absorbing excess acids or bases. Common examples include bicarbonate, hemoglobin, and carbonic acid.

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What triggers MODS?

MODS is often triggered by a severe illness or injury, leading to uncontrolled inflammatory and stress responses in the body.

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MODS Characteristics

MODS is characterized by a hypermetabolic and hyperdynamic state, meaning increased metabolism and heart rate.

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ACE2 Receptor Location

The ACE2 receptor is not only found in the lungs, but also in the kidney, bladder, and small intestine cells.

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Long COVID

Long COVID refers to persistent symptoms of COVID-19 weeks or months after initial recovery.

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Multi-System Inflammatory Syndrome-C (MIS-C)

MIS-C is a rare but severe condition in children where multiple organ systems become inflamed.

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Study Notes

Multi-System Dysfunction

  • This presentation discusses various types of shock and their effects on the body.
  • Shock is a complex clinical syndrome leading to cellular hypoxia and organ failure.
  • It begins as an adaptive response but progresses to multi-system organ failure.
  • The following are different types of shock: hypovolemic, cardiogenic, distributive (septic, anaphylactic, and neurogenic).
  • Multiple interactions of mechanisms lead to decreased intravascular volume, decreased myocardial contractility, and increased venous capacitance.

Types of Shock

  • Hypovolemic Shock: Results from insufficient blood volume in the vascular space. Causes include loss of blood, plasma fluid, and interstitial fluid. This leads to decreased perfusion, causing further drop in blood pressure. Compensatory mechanisms include increased heart rate and vasoconstriction.
  • Cardiogenic Shock: Inability of the heart to pump enough blood to the tissues. Causes include myocardial damage (AMI), cardiomyopathy, sepsis, myocarditis, arrhythmias, and obstruction (PE, cardiac tamponade, or valvular disorders).
  • Distributive Shock: This involves vasodilation, which leads to maldistribution of blood volume.
    • Septic Shock: Triggered by infection bacteria in the blood stream. This results in an inflammatory response and causes vasodilation and increased capillary permeability.
    • Anaphylactic Shock: Caused by a severe allergic reaction. Antibodies react to an allergen resulting in a massive release of inflammatory mediators, inducing vasodilation and increased capillary permeability.
    • Neurogenic Shock: Decreased sympathetic tone and widespread vasodilation result from spinal cord injury or spinal anesthesia. This leads to low blood pressure and potentially problematic decreased tissue perfusion.

Mechanisms of Shock

  • Impaired oxygen use: Cells not properly receiving or utilizing oxygen, leading to sodium and water shift in cells, decreased blood volume and cellular edema. Low ATP leads to cell metabolic acidosis using lactic acid for fuel.
  • Impaired glucose use: Impaired delivery or cell uptake of glucose leads to glycogenolysis, gluconeogenesis, and lipolysis to create fuel for survival. Depletion of protein due to gluconeogenesis leads to muscle wasting.

Process of Shock

  • A life-threatening condition caused by inadequate tissue perfusion that leads to anaerobic metabolism. Left untreated, it will result in cell death, potentially causing irreversible Multi-Organ Dysfunction Syndrome (MODS).

Impairment of Cellular Metabolism

  • The breakdown of cellular function leads to the failure of organ systems and multi-system organ failure.

Clinical Manifestations of Shock

  • Various presentations in adults and children may include hypotension, tachycardia, decreased urinary output, altered mental status, cool clammy skin, and narrowed pulse pressure. The severity of symptoms can range from mildly compensated to completely irreversible.

Systemic Inflammatory Response Syndrome (SIRS)

  • A potentially life-threatening condition. The main criteria are: temperature (< 36°C or > 38°C), heart rate (>90 bpm), respiratory rate (>20 breaths/minute or PaCO2 < 32 mmHg), and white blood cell count (< 4 or >12 x 109/L or >10% bands).

Common Sepsis

  • Common sources of sepsis in acute care include urinary tract infections (urosepsis) leading to systemic sepsis, pneumonia, and integumentary issues (like necrotizing fasciitis).

Post COVID-19: Long Haulers

  • Post-infectious symptoms (weeks or months after recovery from COVID-19). Symptoms may include fatigue, anxiety, depression, memory problems, sleep disturbances, pain, shortness of breath, difficulty concentrating.

COVID-19

  • SARS-CoV-2 invades the host cell by binding to ACE2 receptors.
  • ACE2 receptors are found in alveolar cells, kidney cells, and intestines.
  • The resulting inflammation can cause multi-organ failures.

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