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Premium member Presentation Transcript General Principles of Pathophysiology : General Principles of Pathophysiology Energy Metabolism Perfusion Shock Topics : Topics Define shock in terms of cellular function Review the requirements for adequate cellular perfusion (Fick principle) Review the mechanisms for starling’s law Preload vs. afterload Muscle contraction Topics Continued : Topics Continued Discuss the mechanisms for oxygen transport oxyhemoglobin dissociation curve Define the stages of shock Describe different causes of shock Define multiple organ dysfunction syndrome Shock Defined : Shock Defined Inadequate tissue perfusion Anaerobic metabolism Final Common Pathway! Aerobic Metabolism : Aerobic Metabolism METABOLISM 6 CO2 6 H2O 36 ATP HEAT (417 kcal) Anaerobic Metabolism : Anaerobic Metabolism GLUCOSE METABOLISM 2 LACTIC ACID 2 ATP HEAT (32 kcal) Anaerobic? So What? : Anaerobic? So What? Inadequate Cellular Oxygenation Homeostasis is maintenance of balance : Homeostasis is maintenance of balance Requires proper functioning systems Cardiovascular Respiratory Renal Physiology of Perfusion : Physiology of Perfusion Dependant on 3 components of circulatory system Pump Fluid Container Factors Affecting The Pump : Factors Affecting The Pump Preload Contractile force Frank-starling mechanism Afterload Muscle Anatomy : Muscle Anatomy Contraction: Sliding Filaments : Contraction: Sliding Filaments image from: http://www.accessexcellence.com/AB/GG/muscle_Contract.html What Is Blood Pressure? : What Is Blood Pressure? BP = Cardiac Output X Systemic Vascular Resistance CO = Stroke Volume X Heart Rate What Affects Blood Pressure? : What Affects Blood Pressure? ANS balance Contractility Preload Starling’s law Afterload Autonomic Nervous System Review… : Autonomic Nervous System Review… Quiz Time! Yeah! Jeopardy : Jeopardy Controls vegetative functions,exits the CNS at high in the neck and low in the back. What is the parasympathetic nervous system? Jeopardy : Jeopardy The chief neurotransmitter of the sympathetic nervous system. What is Norepinephrine? Jeopardy : Jeopardy The ‘cutesy’ name for the parasympathetic nervous system. What is ‘Feed or Breed’? Jeopardy : Jeopardy Two types of parasympathetic receptors. What is nicotinic (NMJ) and muscarinic (organs)? Jeopardy : Jeopardy Two types classes of sympathetic receptors. What is alpha and beta? Jeopardy : Jeopardy The ‘cutesy name’ for the sympathetic nervous system. What is ‘fight or flight’? Jeopardy : Jeopardy Stimulation of this receptor causes an increase in peripheral vasoconstriction. What is alpha 1? Jeopardy : Jeopardy Stimulation of this receptor causes an increase in myocardial contractility. What is beta 1? Jeopardy : Jeopardy Stimulation of this receptor causes an increase in bronchodilation. What is beta 2? Jeopardy : Jeopardy Stimulation of this receptor causes a decrease in the sympathetic activation. What is alpha 2? Jeopardy : Jeopardy Two types of parasympathetic receptors. What is nicotinic (NMJ) and muscarinic (organs). Changes in Afterload and Preload : Changes in Afterload and Preload Peripheral vasoconstriction… Changes in Afterload and Preload : Changes in Afterload and Preload Peripheral vasodilation… Changes in Afterload and Preload : Changes in Afterload and Preload fluid volume… Changes in Afterload and Preload : Changes in Afterload and Preload fluid volume… Fluid : Fluid Must have adequate amounts of hemoglobin Must have adequate intravascular volume Maintenance of Fluid Volume : Maintenance of Fluid Volume Renin-Angiotensin-Aldosterone system. Works through kidneys to regulate balance of Na+ and water. Renin-Angiotensin-Aldosterone : Renin-Angiotensin-Aldosterone Plasma volume [Na+] &/Or Renin-Angiotensin-Aldosterone : Renin-Angiotensin-Aldosterone Angiotensin II… Hemostasis : Hemostasis The stoppage of bleeding. Three methods Vascular constriction Platelet plug formation Coagulation Coagulation : Coagulation Formation of blood clots Prothrombin activator Prothrombin thrombin Fibrinogen fibrin Clot retraction Fibrinolysis : Fibrinolysis Plasminogen Tissue plasminogen activator (tPA) Plasmin Disseminated Intravascular Coagulation : Disseminated Intravascular Coagulation “A systemic thrombohemorrhagic disorder … with evidence of: Procoagulant activation Fibrinolytic activation Inhibitor consumption End-organ failure” Bick, R.L. Seminars in Thrombosis and Hemostasis 1996 Pathophysiology of DIC : Pathophysiology of DIC Uncontrolled acceleration of clotting cascade Small vessel occlusion Organ necrosis Depletion of clotting factors Activation of fibrinolysis Ultimately severe systematic hemorrhage Container : Container Vasculature is continuous, closed and pressurized system Microcirculation responds to local tissue needs Blood flow dependent on PVR Fick Principle : Fick Principle Effective movement and utilization of O2 dependent on: Adequate fio2 Appropriate O2 diffusion into bloodstream Adequate number of RBCs Proper tissue perfusion Efficient hemoglobin ‘loading’ Fick Principle : Fick Principle Perfusion = Arterial O2 Content - Venous O2 Content Affected by: Hemoglobin levels circulation of RBCs distance between alveoli and capillaries pH and temperature Onloading Oxygen in Lungs : Onloading Oxygen in Lungs Pressure Saturation oxyhemeglobin deoxyhemeglobin pH 7.4 pH 7.45 pH shifts curve to left ‘onloading’ in lungs Remember: CO2 [H+] Offloading Oxygen in Tissues : Offloading Oxygen in Tissues Pressure Saturation oxyhemeglobin deoxyhemeglobin pH 7.4 pH 7.35 pH shifts curve to right ‘offloading’ to tissues Remember: CO2 [H+] Causes of Inadequate Perfusion : Causes of Inadequate Perfusion Inadequate pump Inadequate preload Poor contractility Excessive afterload Inadequate heart rate Inadequate fluid volume Hypovolemia Inadequate container Excessive dilation Inadequate systematic vascular resistance Responses to Shock : Responses to Shock Normal compensation includes: Progressive vasoconstriction Increased blood flow to major organs Increased cardiac output Increased respiratory rate and volume Decreased urine output Cellular Response to Shock : Cellular Response to Shock Tissue perfusion Stages of Shock : Stages of Shock Compensated Uncompensated Irreversible Compensated Shock : Compensated Shock Defense mechanisms are successful in maintaining perfusion Presentation Tachycardia Decreased skin perfusion Altered mental status Uncompenstated Shock : Uncompenstated Shock Defense mechanisms begin to fail Presentation Hypotension Prolonged Cap refill Marked increase in heart rate Rapid, thready pulse Agitation, restlessness, confusion Irreversible Shock : Irreversible Shock Complete failure of compensatory mechanisms Death even in presence of resuscitation Types of Shock : Types of Shock Hypovolemic Cardiogenic Neurogenic Anaphylactic Septic Hypovolemic Shock : Hypovolemic Shock “Fluid failure” Decreased intravascular volume Causes? “Third spacing” Cardiogenic Shock : Cardiogenic Shock CO Neurogenic Shock : Neurogenic Shock Sympathetic Tone Or Parasympathetic Tone Anaphylactic Shock : Anaphylactic Shock “Container failure” Massive & systemic allergic reaction Large release of histamine Increases membrane permeability & vasodilation Septic Shock : Septic Shock “Container failure” Systemic infection Multiple Organ Dysfunction System : Multiple Organ Dysfunction System Progressive dysfunction of two or more organ systems Caused by uncontrolled inflammatory response to injury or illness Typically sepsis References : References New York Presbyterian hospital hypertension center: Http://pc101186.Med.Cornell.edu/htchome/htbk/Htbkindex.htm Biographics Gallery: http://www.accessexcellence.com/AB/GG/#Anchor-Building-11481 RAS (Renin-Angiotensin-Aldosterone System): http://www.science.mcmaster.ca/Biology/4S03/RAS.HTM A graduate student’s hypertension page: http://www.teaching-biomed.man.ac.uk/student_projects/2000/mnpm6ven/default.htm You do not have the permission to view this presentation. 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