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MindMap Gallery Patient Chapter 13 Shock
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Patient Chapter 13 Shock
This is a mind map about shock in Chapter 13 of patients, including the cause, mechanism, body metabolism and functional changes, etc.
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Patient Chapter 13 Shock
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- Outline
shock
concept
Shock means that under the action of strong pathogenic factors such as severe blood loss and fluid loss, infection, and trauma, the effective circulating blood volume is sharply reduced and the tissue blood perfusion is seriously insufficient, causing cell ischemia and hypoxia, resulting in the function of all important life organs. Systemic critical pathological processes involving metabolic disorders or structural damage.
Causes and Classification
Cause
Blood loss, fluid loss, burns, trauma, infection (pathogenic microorganisms), allergies, cardiac dysfunction, strong nerve stimulation
Classification
According to the cause
Hemorrhagic shock, burn shock, traumatic shock, septic shock, anaphylactic shock, cardiogenic shock, neurogenic shock
According to the starting stage
hypovolemic shock
Three lows and one high: central venous pressure (CVP), cardiac output (CO), and arterial blood pressure decrease, and peripheral resistance (PR) increases
vasogenic shock
cardiogenic shock
The mechanism
microcirculatory mechanism
microcirculatory ischemic phase
Characteristics of changes
During this period, microcirculatory blood perfusion is reduced, tissue ischemia and hypoxia
Features: 1. Precapillary resistance vasoconstriction is more obvious 2. A large number of true capillary networks are closed, and the blood flow rate in the microcirculation slows down. 3. Direct access or arteriovenous short-circuit return, tissue perfusion is significantly reduced
Perfusion characteristics: less perfusion and less flow, less perfusion than flow, and the tissue is in a state of ischemia and hypoxia.
change mechanism
Sympathetic nerves are excited, catecholamines are released into the blood in large quantities, and true capillary volume is reduced.
Release of other vasoconstrictor humoral factors
Compensatory significance
Helps maintain arterial blood pressure: increased blood return to the heart (autotransfusion, autologous infusion), increased cardiac output, and increased peripheral resistance
Helps blood supply to the heart and brain
clinical manifestations
Pale face, clammy limbs, cold sweat, rapid pulse, decreased pulse pressure, decreased urine output, irritability
microcirculatory congestion phase
Characteristics of changes
Characteristics of perfusion: less flow, more flow, and the tissue is in a state of congestion and hypoxia.
change mechanism
Microvascular dilation (acidosis, increased production of vasodilator substances)
Blood stasis (white blood cells adhere to venules, blood becomes concentrated)
Compensatory significance
The amount of blood returned to the heart decreases sharply, self-infusion stops, and the blood perfusion of the heart and brain decreases.
clinical manifestations
Blood pressure and pulse pressure progressively decrease, blood pressure often drops significantly, pulse is thin and rapid, and veins atrophy.
Cerebral blood perfusion is significantly reduced leading to central nervous system dysfunction
Renal blood flow is severely insufficient, resulting in oliguria or even anuria
microcirculatory congestion
Microcirculatory failure stage
Characteristics of changes
Microthrombosis forms, blood flow stops, and a state of no perfusion and no flow occurs.
change mechanism
microvascular paralytic dilation
DIC formation
clinical manifestations
Circulatory failure (refractory hypotension)
Complicated DIC (bleeding, anemia, subcutaneous ecchymosis)
vital organ dysfunction
cellular molecular mechanisms
cell damage
changes in cell membrane
Shock is the first to change
Mitochondrial changes
Swelling, loss of dense structures and ridges, calcium salt deposition, and even membrane rupture
changes in lysosomes
Swelling, vacuolation and release of lysosomal enzymes
cell death
Activation of inflammatory cells and increased expression of inflammatory mediators
Body metabolism and functional changes
Substance metabolism disorder
Electrolyte and acid-base balance disorders
Acid, alkali and hyperkalemia
organ dysfunction
The lungs are easily affected, and the kidneys are affected early. multiple organ dysfunction syndrome