Shock

Question 1

blood pressure in systemic arteries will be lower than normal when blood volume in arteries is reduced due to decreased ______ or decreased ______ (increased runoff from arteries to veins)

Answer 1

cardiac output

TPR

Question 2

diastolic pressure mainly determined by:

• rate of _______, how fast bloods flow from arterial to venous system, determined by TPR
• ______ time, during diastole, determined by heart rate
• arterial _______ pressure, the starting point from which runoff causes pressure to decrease

Answer 2

runoff

runoff

systolic

Question 3

determinants of arterial systolic pressure:

• _______ rate, determines how quickly blood volume in arterial system increases, which infuences peak systolic pressure attained
• _______: arterial pulse pressure is an index, if volume increase, arterial pulse pressure increases
• _______ compliance, increases cause increase in systolic pressure
• arterial ______ pressure: starting point where pressure begins to increase during ejection

Answer 3

ejection

stroke volume

arterial

diastolic

Question 4

calculation of MAP?

Answer 4

MAP= diastolic pressure + (1/3) pulse pressure

Question 5

represents the driving pressure for blood flow in the systemic circulation, the baroreflex response is a negativ feedback system that attempts to maintain it at nearly constant levels

Answer 5

MAP

Question 6

• stretch on myocardial fibers before contraction
• indices: EDV, EDP, venous return
• related to ventricular filling: determined by heart rate (decreased HR increases filling time, increasing stroke volume)
• rate of venous return: increased venous return increases EDV and increases stroke volume

Answer 6

preload

Question 7

law that states when preload increases, the stroke volume increases due to stretch which result s in more favorable overlap of thin and thick filaments, more cross bridge formation

Answer 7

Starling’s Law

Question 8

• the ventricular wall tension during ejection, the resistance that must be overcome to eject blood
• pressure at start of ejection (aortic diastolic pressure) or peak pressure (aortic systolic pressure) are used as indices
• changes in TPR will affect, increased TPR slows rate of runoff which will increase arterial diastolic pressure

Answer 8

afterload

Question 9

• contractility, dependent on cytosolic calcium level within contracting myocytes
• levels submaximal under normal conditions
• norepi will enhance calcium entry into myocytes

Answer 9

inotropic state

Question 10

TPR is mainly due to systemic _______ resistance

Answer 10

arteriolar

Question 11

-constriction of systemic arterioles will increase TPR, decreasing the rate of runoff of blood to from arteries to veins, increasing _______ diastolic pressure, increasing afterload resulting in decreased stroke volume on next beat

Answer 11

arterial

Question 12

• decreased blood volume resulting in inadequate cardiac output
• skin feels cold and clammy
• low central venous pressure

Answer 12

hypovolemic shock

Question 13

• generalized systemic vasodilation
• blood volume initially normal
• warm shock, low resistance

Answer 13

distributive shock

Question 14

• inadequate cardiac output by a diseased or impaired heart
• congested shock due to pump failure
• high central venous pressure
• skin cold and clammy

Answer 14

cardiogenic shock

Question 15

decreased blood volume -> decreased venous return -> decreased stroke volume -> decreased CO –> decreased arterial pressure

Answer 15

hypovolemic shock

Question 16

the ____ and ____ exhibit autoregulation, where flow is maintained nearly constant at low arterial pressures by _________ and at high arterial pressures by local ________

Answer 16

arteriolar dilation

arteriolar constriction

Question 17

• insufficient O2 delivery to the heart relative to O2 consumption
• seen as ST segment shift from normal baseline
• increased consumption: increased inotropic state, afterload, HR, preload, or ventricular hypertrophy
• decreased O2 delivery: decreased coronary bloodflow, decreased arterial O2 levels

Answer 17

myocardial ischemia

Question 18

• hemorrhagic shock: isotonic fluid (blood) lost, so it’s ______ contraction
• dehydration: more water than salt lost, so ECF osmolality is increased, causes water to move out of cells and ICF volume is decreased, this is a _______ contraction

Answer 18

isotonic

hypertonic

Question 19

in septic shock, the pro-inflammatory factors outweigh even high levels of ______ and leukocyte adherence to postcapillary venules occurs, resulting in microvascular injury

Answer 19

nitric oxide

Question 20

• anaphylactic shock involves degranulation of _____ cells in response to allergen
• histamine will increase vascular _______, which will complicate rescucitation

Answer 20

mast

permeability

Question 21

• neurogenic shock is produced by loss of vascular _____ due to inhibition of normal tonic activity of sympathetic vasoconstrictors
• can be treated with an _______ to constrict systemic arterioles which increase TPR

Answer 21

tone

alpha-1 agonist

Question 22

• greater than normal decline in systolic arterial pressure during inspiration
• in cardiac tamponade, the increase in venous return to the right ventricle during ______ causes an exaggerated reduction in left ventricular volume
• the increased filling of the right ventricle during inspiration causes the septum to bulge to the left ventricle, decreasing filling and reducing stroke volume

Answer 22

paradoxical pulse

Question 23

cardiac tamponade causes a ______ ECG recording, where the fluid in the pericardial sac would diminish the magnitude of electrical events recorded on the EKG, heart sounds will be diminished as well

Answer 23

low amplitude

Question 24

in irreversible shock, impaired organ blood flow will lead to accumulation of _______ metabolites, increasing ______ causing acidosis and impaired cell function

Answer 24

vasodilator

lactic acid