1. The document discusses various types of shock including hypovolemic, cardiogenic, anaphylactic, septic, and neurogenic shock. It describes the signs, symptoms, causes, and management of each type.
2. Compensatory mechanisms in shock are discussed, including activation of the sympathetic nervous system and hormones like catecholamines, renin-angiotensin, ADH, and ACTH. Fluid shifts are also described as a compensatory mechanism.
3. The consequences of untreated shock are explained, like decreased organ perfusion leading to issues like stroke, heart attack, acute renal failure, and hypoxemia. The transition from reversible to irreversible shock and examples of
Pharmacology I Drugs acting on CVS
III B.Pharm, II Pharm D
Dr.Shivalinge Gowda KP Asso Professor and HOD
PES College of Pharmacy Bangalore-560050 Karnataka, India
shivalinge65@gmail.com
Classification
Mechanism of action
Duration of action
Absorption and distribution
Mode of action
Theories of action of L.A
Pharmacokinetics of local anaesthetics
Routes of administration
Metabolism or biotransformation
Individual agents
Vasoconstrictors
Systemic effects
Toxicity
Advantages
Disadvantages
Maximum allowable dose
Local anaesthetics in community trust services
Dentist in pune.(BDS. MDS) - Dr. Amit T. Suryawanshi. Nose & Paranasal sinuses.All Good Things
Dentist in pune. (BDS. MDS) - Dr. Amit T. Suryawanshi. Seminar- Nose & Paranasal sinuses.
Email ID- amitsuryawanshi999@gmail.com
Contact -Ph no.-9405622455
Subscribe our channel on youtube - Copy and paste this URL. https://www.youtube.com/channel/UC_gylEXTrjmEbbOTSXjuZ4Q/videos?view_as=public
Follow us on slideshare
oral mucous membranes-1 /orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Pharmacology I Drugs acting on CVS
III B.Pharm, II Pharm D
Dr.Shivalinge Gowda KP Asso Professor and HOD
PES College of Pharmacy Bangalore-560050 Karnataka, India
shivalinge65@gmail.com
Classification
Mechanism of action
Duration of action
Absorption and distribution
Mode of action
Theories of action of L.A
Pharmacokinetics of local anaesthetics
Routes of administration
Metabolism or biotransformation
Individual agents
Vasoconstrictors
Systemic effects
Toxicity
Advantages
Disadvantages
Maximum allowable dose
Local anaesthetics in community trust services
Dentist in pune.(BDS. MDS) - Dr. Amit T. Suryawanshi. Nose & Paranasal sinuses.All Good Things
Dentist in pune. (BDS. MDS) - Dr. Amit T. Suryawanshi. Seminar- Nose & Paranasal sinuses.
Email ID- amitsuryawanshi999@gmail.com
Contact -Ph no.-9405622455
Subscribe our channel on youtube - Copy and paste this URL. https://www.youtube.com/channel/UC_gylEXTrjmEbbOTSXjuZ4Q/videos?view_as=public
Follow us on slideshare
oral mucous membranes-1 /orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
VENOUS DRAINAGE OF HEAD, FACE, NECK AND BRAINDrVishal2
THIS SEMINAR ON VENOUS DRAINAGE OF HEAD, FACE, NECK AND BRAIN ENCOMPASSES ALL THE POSSIBLE DETAILED EXPLANATION ALONG WITH DIAGRAMMATIC ILLUSTRATIONS OF THE SAME. APPLIED AND SURGICAL ANATOMY ALONG WITH RECENT MODALITIES HAS BEEN ADDED HEREIN..
Surfactant & compliance, LAW OF LAPLACE, Work of Breathing (the guyton and ha...Maryam Fida
It is a lipoprotein mixture present in thin layer of fluid lining the alveoli at the air fluid interface.
COMPOSITION
It is composed of
Apoprotein
Calcium ions
Phospholipids i.e. dipalmitoyl lecithin
Surfactant is secreted by
1. Mainly type II alveolar cells in the lungs.
2. Clara cells, which are situated in the bronchioles.
It lowers the surface tension of fluid lining the alveoli.
Surface tension is inversely proportional to surfactant concentration.
During inspiration surfactant molecules move apart as lungs are expanded and during expiration surfactant molecules become concentrated as lungs shorten.
When there is no surfactant, Surface Tension is 50 dynes/cm. when surfactant is present it is 5-30 dynes/cm depending upon the concentration
Prevents collapse of lungs
Stabilize size of alveoli
Surfactant helps to keep lungs expanded. If there is deficiency of surfactant then the pressure of -20 to -30 mm of Hg will be required to keep the lungs expanded
Surfactant also helps to keep the alveoli dry and prevent development of pulmonary edema.
Surfactant is also helpful in lung expansion at birth. If there is deficiency then there is Respiratory Distress Syndrome.
LAW OF LAPLACE:
pressure required to keep a hollow viscous distended = 2 T/R
Where T is tension and R is radius.
During expiration, size of alveoli decreases so R is decreased and if T does not decrease, much higher pressure will be required to keep the alveoli distended.
When adequate amount of surfactant is there T also decreases so increased pressure is not required. This prevents the collapse of lungs and also stabilizes the equal size of alveoli
Definition:
“Compliance is the measure of expansibility or distensibility of the lungs. It indicates with how much ease lungs can be expanded”.
Work of Breathing
In certain diseases there is increased work of breathing and depending upon the nature of breath there will be specific increase in work of breathing.
In asthma there is increase in work of breathing to overcome airway resistance
In restrictive lung diseases there is increase work of breathing in both tissue resistance and elastic recoil.
Summary notes of Anesthesia. These notes were published in 2020.
You can download them from:
-Mediafire: http://www.mediafire.com/file/wkey81yff7kv3j1/Anesthesia_Q%2526A_2020.pdf/file
VENOUS DRAINAGE OF HEAD, FACE, NECK AND BRAINDrVishal2
THIS SEMINAR ON VENOUS DRAINAGE OF HEAD, FACE, NECK AND BRAIN ENCOMPASSES ALL THE POSSIBLE DETAILED EXPLANATION ALONG WITH DIAGRAMMATIC ILLUSTRATIONS OF THE SAME. APPLIED AND SURGICAL ANATOMY ALONG WITH RECENT MODALITIES HAS BEEN ADDED HEREIN..
Surfactant & compliance, LAW OF LAPLACE, Work of Breathing (the guyton and ha...Maryam Fida
It is a lipoprotein mixture present in thin layer of fluid lining the alveoli at the air fluid interface.
COMPOSITION
It is composed of
Apoprotein
Calcium ions
Phospholipids i.e. dipalmitoyl lecithin
Surfactant is secreted by
1. Mainly type II alveolar cells in the lungs.
2. Clara cells, which are situated in the bronchioles.
It lowers the surface tension of fluid lining the alveoli.
Surface tension is inversely proportional to surfactant concentration.
During inspiration surfactant molecules move apart as lungs are expanded and during expiration surfactant molecules become concentrated as lungs shorten.
When there is no surfactant, Surface Tension is 50 dynes/cm. when surfactant is present it is 5-30 dynes/cm depending upon the concentration
Prevents collapse of lungs
Stabilize size of alveoli
Surfactant helps to keep lungs expanded. If there is deficiency of surfactant then the pressure of -20 to -30 mm of Hg will be required to keep the lungs expanded
Surfactant also helps to keep the alveoli dry and prevent development of pulmonary edema.
Surfactant is also helpful in lung expansion at birth. If there is deficiency then there is Respiratory Distress Syndrome.
LAW OF LAPLACE:
pressure required to keep a hollow viscous distended = 2 T/R
Where T is tension and R is radius.
During expiration, size of alveoli decreases so R is decreased and if T does not decrease, much higher pressure will be required to keep the alveoli distended.
When adequate amount of surfactant is there T also decreases so increased pressure is not required. This prevents the collapse of lungs and also stabilizes the equal size of alveoli
Definition:
“Compliance is the measure of expansibility or distensibility of the lungs. It indicates with how much ease lungs can be expanded”.
Work of Breathing
In certain diseases there is increased work of breathing and depending upon the nature of breath there will be specific increase in work of breathing.
In asthma there is increase in work of breathing to overcome airway resistance
In restrictive lung diseases there is increase work of breathing in both tissue resistance and elastic recoil.
Summary notes of Anesthesia. These notes were published in 2020.
You can download them from:
-Mediafire: http://www.mediafire.com/file/wkey81yff7kv3j1/Anesthesia_Q%2526A_2020.pdf/file
Shock: types of shock, treatment - General Medicine - ATOTDr. Salman Ansari
Topic: Shock
Faculty: Medicine
Course: BSc ATOT - 2nd year
Definition
Types of shock with examples
Hypovolemic shock
Cardiogenic shock
Septic shock
Clinical features
Treatment of shock
Critical Care Nurse Student | Assistant Clinical Researcher | Chairperson National Nurses of Kenya-Siaya Branch | Mentor | SRHR & Boys Advocate.
Young and energetic healthcare professional with a strong belief in the basic tenets of human development and quality of life. My key qualities include integrity, hardworking, team player and keenness to achieve results.
Shock is a critical condition brought on by the sudden drop in blood flow through the body. Shock may result from trauma, heatstroke, blood loss, an allergic reaction, severe infection, poisoning, severe burns or other causes. When a person is in shock, his or her organs aren't getting enough blood or oxygen.
shock is the state of insufficient blood flow to the tissues of the body .it contains introduction, definition, stages of shock, types of shock, diagnostic evaluation, prognosis ,prevention, care for each stage.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Evaluation of antidepressant activity of clitoris ternatea in animals
SGD- Managemet of Shock
1. SGD: Management of Shock
Dr. Sai Sailesh Kumar G
Associate Professor
Department of Physiology
RD Gardi Medical College
Ujjain, Madhya Pradesh
Email:dr.saisailesh@gmail.com
2. Learning objectives
1. Define shock
2. Describe physiological pathways operative in shock
3. List the causes of shock and briefly describe them
4. Discuss the principles of treatment of shock
3. Case-1
A 40 years old lady in anxiety was brought to the
Emergency Department with history of repeated
diarrhea and vomiting of one day duration. Her
main symptoms were severe exhaustion,
giddiness and decrease in urine output. On
examination her skin was cold and calmy, dry
mouth, pulse was 100 bpm and thready, BP 80/50
mmHg.
A. What is the most likely clinical diagnosis?
B. What is the basis of the signs and symptoms?
C. What is the physiological basis of the treatment?
D. What is the outcome if treatment fails?
4. Case-2
An individual was brought to hospital from the
Road accident site. He showed following signs
and symptoms. Restlessness, Extreme
Weakness, Pale Cold Clammy skin, Rapid &
thready pulse, Hypotension, oliguria.
A. What is your diagnosis?
B. How do you explain the signs and symptoms?
C. Explain Compensatory mechanism.
D. What immediate treatment do you suggest
5. Case-3
Can I treat a hypovolemic shock patient with
sympathomimetic drugs?
6. Management of shock
Replacement therapy
1. Blood and plasma transfusion: if a person is in shock
caused by hemorrhage, the best possible therapy is
transfusion of whole blood
2. If whole blood is not available, plasma transfusion can be
done to increase blood volume
3. Plasma can not increase hematocrit but human body can
usually stand a decrease in the hematocrit to half of normal
before serious consequences result
4. If plasma is not available use plasma substitutes like dextran
solution
7. Management of neurogenic and anaphylactic shock
Sympathomimetic drugs
1. A sympathomimetic drug is a drug that mimics
sympathetic stimulation
2. Nor-epinephrine and epinephrine
3. In two types of shock, these drugs have proved to
be especially beneficial
4. Sympathomimetic drugs have not proved to be very
valuable in hemorrhagic shock.
8. Management of neurogenic and anaphylactic shock
Sympathomimetic drugs
1. Sympathomimetic drugs have not proved to be very
valuable in hemorrhagic shock.
2. In hypovolemic shock, the sympathetic nervous system
is almost always maximally activated by the circulatory
reflexes already
3. So much of nor epinephrine and epinephrine already
circulating in the blood
4. Sympathomimetic drugs have not proved to be very
valuable in hemorrhagic shock.
9. Management of shock
Other therapies
1. Head down position: when the pressure falls too low
in most types of shock, especially in the hemorrhagic
and neurogenic shock, placing the patient with the head
at least 12 inches lower than the feet
2. Improves venous return
3. Increases cardiac output
4. First essential step in managing many types of shock
10. Management of shock
Other therapies
1. Oxygen therapy: major deleterious effect of most
types of shock is too little delivery of oxygen to the
tissues giving the patient oxygen to breathe can be
of benefit
2. However, in most of types of shock, is not due to
inadequate oxygenation but due to inadequate
transport of blood after it is oxygenated
11. Management of shock
Other therapies
1. Glucocorticoids: increases strength of the heart in
later stages of the shock
2. Stabilize lysozymes in tissue cells and prevents
release of lisosomal enzymes into the cytoplasm of
cells
3. Aid metabolism of glucose
12. Circulatory shock
Generalized inadequate blood flow through the body to
the extent that the body tissues are damaged,
especially because of too little oxygen and other
nutrients are delivered to the tissue cells.
13. What happens to BP in Circulatory shock
1. Some cases in severe shock, person still have
almost normal BP due to powerful nervous reflexes
2. At other times, BP can fall to half normal, but the
person still has normal perfusion and is not in shock
3. In shock due to severe blood loss, BP decreases at
the same time cardiac output decreases. Although
usually not as much
14. Why cardiac depression in shock
1. Decrease in BP
2. Coronary blood flow decreases
3. Myocardium is not supplied with adequate nutrition
4. Weakens the heart muscle
5. Decreases cardiac output
6. Positive feedback cycle
15. Why cardiac depression in shock
1. Septic Shock- Endotoxins released from bodies of
dead gram negative bacteria in the intestines
2. Decreased blood flow in intestines often causes
enhanced formation and absorption of these
endotoxins
3. Circulating toxin increases cellular metabolism
despite inadequate nutrition of cells
4. Especially affect cardiac muscles causing cardiac
depression
16. Circulatory shock
1. Decrease in the Blood Pressure.
2. Perfusion of the organs falls.
3. Fall in cerebral perfusion pressure
4. Ischemia of neuronal cells
5. Brain death
17. Reversible and irreversible shock
1. To combat with damaging effects of shock, body
develops compensatory mechanisms
2. These mechanisms, up to a limit, can protect the
body from damages
3. As long as the compensatory mechanisms are
effective, the shock is called reversible shock
18. Reversible and Irreversible shock
1. If untreated shock, the compensatory mechanisms
breakdown
2. Some compensatory mechanisms become counter
productive (Positive feedback)
3. Now the shock is stated as irreversible shock
19. Reversible and Irreversible shock
1. If untreated shock, the compensatory mechanisms
breakdown
2. Some compensatory mechanisms become counter
productive (Positive feedback)
3. Now the shock is stated as irreversible shock
20. Reversible and Irreversible shock
1. Reversible and irreversible terms are old terms
2. In the past, patients with irreversible shock used to
die, but now not necessarily so
3. Hence, there terms can be dropped
4. Compensatory or early shock and
decompensated or advanced stage of shock
should be used
21. Counter productivity in shock
1. In early phase of shock, renal vasoconstriction
occurs
2. Lowers renal filtration
3. Lowers loss of fluid via urine
4. Conservation of body fluids
5. In advanced stage of shock, renal filtration stops
altogether
6. Anuria – renal acidosis – hyperkalemia - death
22. Counter productivity in shock
1. In early phase of shock, sympathetic stimulation
occurs
2. Splanchnic vasoconstriction
3. This blood is diverted for better perfusion of brain
4. In advanced stage of shock, prolonged
vasoconstriction of intestines
5. Sloughing of intestinal mucosa
6. Massive entry of gram negative bacteria
7. Septic Shock
23. Counter productivity in shock
1. In infection, various mediators (cytokines,
interleukins etc.) released by cells of body
2. These mediators help to battle with infection by
local vasodilation
3. In advanced stage of infection, severe vasodilation
4. Septicemic Shock
24. Counter productivity in shock
All these examples mean, in early stage of shock, the
shock must be effectively treated, otherwise there can
be grave consequences.
25. Consequences of shock
1. Decrease in the perfusion of vital organs
2. Brain – stroke ( particularly in old atherosclerotic
person)
3. Heart – Acute Myocardial Infarction (AMI)
4. Kidney – Acute Renal Failure (ARF)
5. Lungs – Mismatched V/P ratio – hypoxemia and
hypercapnia
26. Compensatory mechanisms of shock
1. Neural and endocrinal responses
2. Neural- As BP falls – Baro-receptor mechanism –
Vasomotor area activated – Sympathetic stimulation
– BP restored – perfusion restored
3. Endocrinal
A. Catecholamine
B. Renin- Angiotensin
C. ADH
D. ACTH responses
27. Catecholamine's
1. Nor adrenaline and adrenaline released from
adrenal gland in response to shock
2. These two hormones collectively called as
catecholamines
3. They cause vasospasm
4. Restoration of BP
28. Renin-angiotensin
1. In shock, kidney is under perfused
2. Formation of angiotensin II
3. Powerful vasoconstriction
4. Also stimulates aldosterone secretion
5. Aldosterone causes sodium retention which in turn
causes water retention
6. Increase in ECF volume ( blood volume) and
restoration of perfusion pressure
29. ADH
1. In shock, sharp fall of BP
2. ADH secretion from posterior pituitary
3. Reduce volume of urinary output
4. Increase in the volume of blood
5. In high doses it acts as vasoconstrictor
30. ACTH
1. In shock, high levels of stress
2. Heavy amount of ACTH secreted from anterior
pituitary
3. ACTH stimulates cortisol secretion
4. Cortisol facilitates vasoconstrictor action of
catecholamines
31. Role of fluid shift mechanism
1. In shock, sharp fall in BP
2. Decrease in hydrostatic pressure
3. Colloidal osmotic pressure remains same
4. In driving force is more than out driving force
5. Tissue fluid enters vascular compartment
6. Restoration of perfusion pressure
33. Hypovolemic shock
1. Occurs in conditions like hemorrhage, burns,
severe diarrhea
2. Pallor – paleness of skin due to cutaneous
vasoconstriction
3. Air hunger – due to hypoxemia and hypercapnia
4. Oliguria – due to renal vasoconstriction
34. Hypovolemic shock – plasma loss
1. Loss of plasma without loss of RBC reduce total
blood volume and cause hypovolemic shock
2. Severe burns cause loss of plasma through the
denuded skin areas so that plasma volume
decreases markedly
35. Hypovolemic shock – Trauma
1. Most common cause of circulatory shock is trauma
to the body
2. Shock results from hemorrhage caused by trauma
3. Hypovolemia
36. Management of hypovolemic shock
1. Removal of cause – stopping the bleeding
2. Restoration of fluid – transfusion of
saline/blood/plasma, etc.,
3. Oxygen inhalation
4. Correction of acidosis if any due to renal failure
5. ORS is given in case of diarrhea instead of fluid
transfusion
37. Cardiogenic shock
1. Occurs in conditions like AMI (Acute Myocardial
Infarction) resulting in heart failure
2. Pulmonary edema –Accumulation of blood due to
failure of left ventricle + hypervolemia of blood
3. Air hunger - due to pulmonary edema
4. Cold, pale skin due to reflex vasoconstriction due to
low BP
38. Management of cardiogenic shock
1. Oxygen inhalation
2. Veno-dilators (e.g. Nitrates) to relieve pulmonary
edema
3. Dobutamine (cardiac stimulant) is often used
39. Anaphylactic shock
1. This is an allergic condition in which the cardiac
output and arterial pressure decreases drastically
2. It primarily results from antigen – antibody reaction
that rapidly occurs after an antigen to which the
person is sensitive enters the circulation
3. Histamine is releases from basophils in the blood
and mast cells in the peripheral tissues
4. Intravenous injection of large amount of histamine
causes histamine shock
40. Anaphylactic shock
1. Occurs in conditions like after injection of drug like
penicillin to a patient who is sensitive to that drug
(penicillin in this example)
2. In anaphylactic shock, after the injection to the
sensitized person, massive amounts of histamine
and some other chemicals are liberated
3. Histamine relaxes vascular smooth muscle but
causes bronchospasm
4. Sharp fall in BP and asthma
41. Management of anaphylactic shock
1. Adrenaline injection (vasoconstrictor and
bronchodilator)
2. Antihistamines
3. Corticosteroids are also given but their effects begin
only some times after
4. If not treated immediately, anaphylactic shock can
kill the patient
42.
43.
44.
45.
46. Septic shock
1. Occurs in conditions like severe bacteremia,
particularly due to gram negative bacteria
2. Gram negative bacteria causes release of
mediators like cytokines, TNF and interleukins
3. These mediators causes vasodilation and
hypotension
4. Also causes cardiac insuficiency, hypoxemia,
edema
47. Septic shock
1. Formerly known as blood poisoning
2. Most cases of septic shock is by gram positive
bacteria followed by endotoxin- producing gram
negative bacteria
3. Septic shock is extremely important to clinician
because other than cardiogenic shock, septic shock
is most frequent cause of shock related death in the
modern hospital.
48. Typical causes of Septic shock
1. Peritonitis caused by spread of infection spread
from uterus and fallopian tubes
2. Generalized body infection resulting from spread of
a skin infection such as streptococcal and
staphylococcal infection
3. Generalized gas gangrene infection by gas
gangrene bacilli
4. Infection spreading into the blood from kidney
caused by colon bacilli
49. Septic shock
1. In later stages, renal failure, and multiple oran
failure may occurs
2. Management:
3. Proper antibiotic therapy
4. Oxygen inhalation ( Oxygen therapy)
5. Nor adrenaline injection to increase BP
6. Treatment of organ failure- use of corticosteroids
50. Neurogenic shock
1. No loss of blood volume
2. Vascular capacity increases so much that even the
normal amount of blood is incapable of filling the
circulatory system adequately
3. Sudden loss of vasomotor tone through out the body
4. Severe vasodilatation of veins – neurogenic shock
5. Deep general anesthesia depress the vasomotor center
6. Brain damage causes paralysis of vasomotor center
51. Case-1
A 40 years old lady in anxiety was brought to the
Emergency Department with history of repeated
diarrhea and vomiting of one day duration. Her
main symptoms were severe exhaustion,
giddiness and decrease in urine output. On
examination her skin was cold and calmy, dry
mouth, pulse was 100 bpm and thready, BP 80/50
mmHg.
A. What is the most likely clinical diagnosis?
B. What is the basis of the signs and symptoms?
C. What is the physiological basis of the treatment?
D. What is the outcome if treatment fails?
52. Case-2
An individual was brought to hospital from the
Road accident site. He showed following signs
and symptoms. Restlessness, Extreme
Weakness, Pale Cold Clammy skin, Rapid &
thready pulse, Hypotension, oliguria.
A. What is your diagnosis?
B. How do you explain the signs and symptoms?
C. Explain Compensatory mechanism.
D. What immediate treatment do you suggest
53. Case-3
Can I treat a hypovolemic shock patient with
sympathomimetic drugs?