PathomechanismofShock病理机制的冲击.pptVIP

Pathomechanism of Shock and Disseminated intravascular coagulation (DIC) Nicole Meissner-Pearson Shock occurs when the rate of arterial blood flow is inadequate to meet metabolic tissue needs and is the consequence of cardio-vascular collapse Essentials of diagnosis are Hypotension (60 mmHG) Tachycardia Oliguria Altered mental status Peripheral hypoperfusion and hypoxia Mechanisms of blood pressure regulation:Blood pressure is proportionate to cardiac output and peripheral vascular resistance Mechanisms of blood pressure regulation Three major types of shock Hypovolemic shock Decreased intravascular volume resulting form loss of blood, plasma, or fluids and electrolytes Cardiogenic shock Pump failure due to myocardial damage or massive obstruction of outflow tracts Distributive shock Reduction of vascular resistance form Sepsis Anaphylaxis Systemic inflammatory response syndrome (SIRS) Hypovolemic shock (most common type of shock) Loss of blood (hemorrhagic) External bleeding (wound to the outside or gastrointestinal) Internal bleeding (hematoma, hemothorax, hemopertitoneum) Loss of plasma Burns Exfoliative dermatitis Loss of fluids and electrolytes External (vomiting, diarrhea, excessive sweating) Internal ( “third spacing” = pancreatitis, ascitis, bowl obstruction Excessive sweating Stages of hypovolemic shock Mild (loss of 20% blood volume) Few external signs in supine young patients but Increased capillary refill time ( longer 3 sec. = 10% volume loss) Moderate (loss of 20-40% blood volume) Patient becomes increasingly anxious and tachycardic 100 beats/min (sympathetic response) oliguria blood pressure may be maintained in supine patient Severe (loss of 40% blood volume) Classic signs of shock appear with hemodynamic instability (Cave: if mental confusion occurs is an ominous clinical sign) Only very short time frame may separate mild and severe shock symptoms that lead, when left untreated, to progressive and irreversible cell injury and death Ca