2. • Fluid Homeostasis:
Blood should be maintained in liquid form, vessel
wall (endothelial cell) integrity , maintenance of
Intravascular pressure & osmolarity.
• Hemodynamic derangements:
1.Edema
2.Congestion
3.Thrombosis
4.Embolism
5.Shock
3. EMBOLISM
• Definition- Embolus is a detached intravascular
mass carried by the blood to distant site from
the point of origin.
• It can be solid, liquid or gaseous form
• Types:
1) Systemic embolism
2) Pulmonary embolism
3) Air embolism
4) Amniotic fluid embolism
5)Fat embolism
4. Systemic Embolism
• Thrombi arising within the heart travel through
the arterial circulation.
• EX: Myocardial Infarction
-Rheumatic heart disease
-Atrial fibrillation
Treatment: Anticoagulants,
Supportive care & embolectomy.
5. Pulmonary embolism
• Thromboembolic occlusion of large or medium
sized pulmonary vessels.
• Causes
• Deep vein thrombosis(95%)- m/c source.
(DVT, Popliteal, iliac or femoral veins)
• Hospitalisation, severe burns, trauma , fractures
hip.
6.
7.
8. Amniotic fluid embolism
• Occurs as postpartum complication – Infusion of
amniotic fluid & its contents into the maternal
circulation.
• Grave complication leading to death.
9. Air embolism(Gas)
• Caisson disease (decompression sickness)
• Occurs – Deep sea divers
- Workers of under ground tunnels
Features:
• Sudden changes in atmospheric pressure.
• Air breathed in high pressure dissolves in blood
& tissue fluids.
• Gases come out of the circulation as bubbles or
form emboli.
10. • Clinical features:
• Pain in joints, muscles & SOB- bends, chokes &
multiple ischemic areas in organs &
bones(femur)
11.
12. Fat embolism
• Occurs – Fracture of long bone, pelvis , Diabetes
mellitus
Pathology:
• Micro globules of fat form emboli
Block small vessels of lungs, brain & kidneys.
Fat embolism syndrome- ARDS of lung(Acute
Respiratory Distress syndrome)
13.
14. SHOCK
• DEFINITION: Circulatory collapse as a result of
wide spread hypo perfusion of tissues due to
reduction of cardiac output or effective
circulatory volume.
• Types of shock:
• 1)Cardiogenic shock
• 2)Hypovolemic shock
• 3)Septic shock
• 4)Neurogenic shock
• 5)Anaphylactic shock
15. 1.Cardiogenic shock:
• Myocardial Infarction
• Arrythmias
• After pulmonary embolism / extrinsic pressure on
the heart due to Pericardial effusion
Failure of cardiac pump
Reduction in cardiac output
SHOCK
16. 2. Hypovolemic shock
Severe burns
Acute Gastro-enteritis
Trauma
Fluid & blood loss
Reduction in blood & plasma volume
SHOCK
18. 5.Septic shock:
Bacterial infections caused by E.coli , pneumoniae,
pseudomonas , bacteriodes & staphylococci
(Lipopolysaccharides –LPS) Indotoxins of the
bacterial wall
Binding protein in the serum
CD14 of leucocytes
Endothelial cells
combine
Contd….
19. • Release mediators of both cytokines &
arachidonic acid metabolites
Capillary thrombosis
Intravascular coagulation(DIC)
Vasodilation
SEPTIC SHOCK
In turn causes
21. Stages of shock
1.Stage I- Non-progressive early stage (compensated
phase)
-Vasoconstriction of arteriolar bed & ADH secretion occurs
-Renal Angiotensin Aldosterone system is activated.
2.Stage II-Progressive stage
- If the cause is still persisting along with additional stress
shock continues with multifailure onset. Respiratory
symptoms like tachypnoea & ARDS set in
22. • STAGE-III: Irreversible stage
• Marked reduction in cardiac output. Ischemic
cell death occurs in various organs
COMA
Progressive Renal failure
Uremia
