Shock And Sepsis

Shock is a clinical syndrome that occurs when there is insufficient blood flow to the body's tissues, leading to inadequate tissue perfusion. This can be caused by various factors such as low blood volume, heart failure, or severe infection. Inadequate tissue perfusion means that the organs and tissues are not receiving enough oxygen and nutrients, which can lead to organ damage and failure if not promptly treated. Therefore, the statement that shock is a clinical syndrome resulting from inadequate tissue perfusion is true.

In distributive shock, there is a decrease in peripheral resistance, which refers to the resistance to blood flow in the blood vessels outside of the heart. This decrease in resistance causes the blood vessels to dilate, leading to an increase in the diameter of the blood vessels and a decrease in blood pressure. Consequently, low blood pressure is observed in distributive shock.

Disruption of ion pumps and cell membrane breakdown are common occurrences in cases of shock. Shock is a condition where the body's organs and tissues do not receive enough blood flow and oxygen, leading to various physiological imbalances. The disruption of ion pumps, which regulate the movement of ions across cell membranes, can result in an imbalance of electrolytes and impaired cellular function. Additionally, cell membrane breakdown can lead to the release of intracellular contents, causing further damage and inflammation. Therefore, it is true that these disruptions are often associated with shock.

DECREASE PRELOAD -> decrease SV -> decrease CO -> decrease O2 delivery

Rehydration is often impeded by concurrent vomiting, and deterioration may be rapid
Rapid loss of intravascular volume reduces ventricular preload
→ decreased stroke volume and cardiac output
→ decreased oxygen delivery

If the cardiac output (C.O) falls too low, it means that the amount of blood being pumped by the heart per minute is insufficient. In order to compensate for this, the body tries to raise the systemic vascular resistance (SVR) to maintain blood pressure (BP). However, if the C.O is already too low, increasing the SVR further will not be able to maintain the blood pressure anymore. Therefore, the statement is true.

lactic acid buildup due to aneirobic metabolism
then you see cell membrane disruption and failure of Na pump, more -->influx of Na, and efflux of K, also vasoconstriction leading to peripheral ppooling of blood

Constriction of arterioles leads to reductions in number of capillary beds that are perfused
Limits the surface area across which filtration occurs
Results in a derangement of cellular metabolism & ultimately organ failure

Once the ABC's (Airway, Breathing, Circulation) have been performed, several actions should be taken. These include improving circulation and systemic oxygen, administering antibiotics if sepsis had occurred, and close monitoring of vital signs. These actions are necessary to ensure the patient's overall well-being and to address any potential complications that may have arisen.

DO2= CaO2 * CO

breathing- ventilation adequate O2 delivery
circulation- feel for carotid pulse, femoral, brachial

Systemic venous resistance refers to the resistance to blood flow in the systemic veins. It depends on various factors, including mean arterial pressure, central venous pressure, and cardiac output. Mean arterial pressure represents the average pressure in the arteries during one cardiac cycle, central venous pressure represents the pressure in the right atrium, and cardiac output represents the volume of blood pumped by the heart per unit of time. All of these factors contribute to the overall resistance in the systemic venous system.

CO= SV. HR

HR increases as a compensation

The statement is true because the luminal diameter of the arterioles plays a crucial role in determining the systemic vascular resistance (SVR). Arterioles are small blood vessels that regulate blood flow and control the resistance to blood flow. When the diameter of arterioles decreases, the resistance to blood flow increases, leading to an increase in SVR. Conversely, when the diameter of arterioles increases, the resistance to blood flow decreases, resulting in a decrease in SVR. Therefore, the luminal diameter of the arterioles directly affects SVR.

The correct answer is HR*SV because it represents the relationship between heart rate (HR) and stroke volume (SV). HR refers to the number of times the heart beats per minute, while SV refers to the volume of blood pumped out by the heart with each beat. Multiplying HR and SV gives the cardiac output (CO), which is the total volume of blood pumped by the heart in one minute. Therefore, HR*SV accurately describes CO.

surgery is required because something is obstructed

SIRS stands for Systemic Inflammatory Response Syndrome, which is a clinical condition characterized by widespread inflammation in the body. It can be caused by various factors, including infection, trauma, or other inflammatory conditions. On the other hand, sepsis is a severe form of infection that can lead to organ dysfunction. While sepsis is always related to infection, SIRS can occur without an infection being present. Therefore, the statement that SIRS is not always related to infection whereas sepsis is, is true.

The correct answer is "all of the above". Hypovolemic shock is caused by a decrease in blood volume, leading to inadequate tissue perfusion. Gastroenteritis, burns, trauma, surgery, and interstitial loss such as ascites, sepsis, and burns can all result in fluid loss and contribute to hypovolemic shock.

The cycle of shock begins with a decrease in oxygen delivery, which leads to an increase in the body's need for oxygen. This mismatch between oxygen supply and demand results in cellular injury. As a response to the injury, inflammatory materials are released, causing functional and structural changes to the blood vessels. These changes further contribute to hypoperfusion, or inadequate blood flow, which ultimately leads to a decrease in the delivery of oxygen.

veins and arteries become floppy and pool blood
this is a relative hypovolemic shock even though no blood is lost
vasodilation occurs which results in increase venous capacitance

Delay in recognizing and quickly treating shock can indeed lead to a progression from compensated reversible shock to widespread multiple system organ failure. However, it is important to note that if left untreated, this can ultimately lead to death. Therefore, the statement that delay in treating shock does not result in death is false.

impairment of cardiac contractility

when CO drops SVR rises to maintain the blood pressure so that the heart and brain is perfused

Obstructive shock is characterized by physical obstruction of the great vessels or the heart itself. This can occur due to conditions such as pulmonary embolism, cardiac tamponade, or tension pneumothorax. These obstructions prevent proper blood flow and can lead to inadequate oxygen supply to the body's tissues, resulting in shock. Therefore, the correct answer is obstructive.

decrease in preload= hemorrhage
that will decrease SV, and that will decrease CO

Autoregulation = maintenance of blood flow over a wide range of perfusion pressures but when it falls below 60 it can't regulate it any longer

Hypoxic shock refers to a state where there is an absolute lack of oxygen delivery to the tissues. This means that the tissues are not receiving enough oxygen to function properly. On the other hand, ischemic shock is a condition where there is not enough glucose or oxygen reaching the tissues. While both conditions involve insufficient oxygen or glucose supply, the key difference lies in the absolute lack of oxygen delivery in hypoxic shock, whereas ischemic shock involves inadequate delivery of both oxygen and glucose. Therefore, the correct answer is that hypoxic shock is an absolute lack of oxygen delivery, while ischemic shock is not enough glucose or oxygen.

Distributive shock is a condition characterized by widespread vasodilation, which leads to a decrease in blood pressure and inadequate tissue perfusion. Hemorrhage, sepsis, anaphylaxis-vasodilation, and drugs that cause vasodilation are all examples of conditions that can cause distributive shock. However, head injury does not directly cause vasodilation and is not typically associated with distributive shock.

Sepsis = systemic inflammatory response triggered by the presence of infectious agents or their toxins
massive NO release-->vasodilation (distributive_
Sepsis may disrupt capillary integrity → intravascular fluid leak into tissue third spaces → hypovolemic effect
Many different circulating toxins & inflammatory mediators can depress myocardial function & reduce cardiac contractility
Cardiogenic component
Over-activation of the clotting cascade can result in DIC → directly plug and block critical tissue beds
Microvascular obstructive shock

SV stands for stroke volume, which is the amount of blood pumped out of the heart with each contraction. The stroke volume is influenced by preload, which is the amount of blood in the heart before it contracts, afterload, which is the resistance the heart must overcome to pump blood out, and contractility, which is the strength of the heart's contraction. Therefore, the statement suggests that the stroke volume is determined by these factors.