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BIOC33H3 (127)

Shock, Systemic Inflammatory Response Syndrome

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University of Toronto Scarborough
Biological Sciences
Stephen Reid

Chapter 67 Shock Systemic Inflammatory Response Syndrome and Multiple Organ Dysfunction SyndromeSHOCKShock is a syndrome characterized by decreased tissue perfusion and impaired cellular metabolism resulting in an imbalance between the supply of and demand for oxygen and nutrients Shock can be classified as low blood flow cardiogenic and hypovolemic shock or maldistribution of blood flow septic anaphylactic and neurogenic shockCardiogenic ShockCardiogenic shock occurs when either systolic or diastolic dysfunction of the pumping action of the heart results in compromised cardiac output CO Precipitating causes of cardiogenic shock include myocardial infarction MI cardiomyopathy blunt cardiac injury severe systemic or pulmonary hypertension cardiac tamponade and myocardial depression from metabolic problems Hemodynamic profile will demonstrate an increase in the pulmonary artery wedge pressure PAWP and pulmonary vascular resistance Clinical manifestations of cardiogenic shock may include tachycardia hypotension a narrowed pulse pressure tachypnea pulmonary congestion cyanosis pallor cool and clammy skin decreased capillary refill time anxiety confusion and agitation Hypovolemic ShockHypovolemic shock occurs when there is a loss of intravascular fluid volume Absolute hypovolemia results when fluid is lost through hemorrhage gastrointestinal GI loss eg vomiting diarrhea fistula drainage diabetes insipidus hyperglycemia or diuresis Relative hypovolemia results when fluid volume moves out of the vascular space into extravascular space eg interstitial or intracavitary space and this is called third spacingThe physiologic consequences of hypovolemia include a decrease in venous return preload stroke volume and CO resulting in decreased tissue perfusion and impaired cellular metabolism Clinical manifestations depend on the extent of injury or insult age and general state of health and may include anxiety an increase in heart rate CO and respiratory rate and depth and a decrease in stroke volume PAWP and urine output
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