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PA4 Haemodynamic alteration2 (Shock) (Morphology (heart (become browness…
PA4 Haemodynamic alteration2 (Shock)
Definition
Robin
profound hemodynamic嚴重血液動力學
metabolic alteration代謝改變
insufficiency of the circulatory system to maintain an adequate blood supply in the microcirculation
deficiency in the perfusion of the vital organs重要器官
shock ≠ Arterial hypotension動脈性低血壓
dramatic fall in the tension緊張--> evolved phases when the compensating mechanisms補償機制 have failed
shock is a process, compose by different stage
progressive stage : defined by the hypo-function , no solution
irreversible stage : relieve a important problem, anti-damage cell
not progressive : compulsory mechanism
physiopathological and types
Classic
septic shock化膿性休克
poor distribution of blood
characteristic
systemic inflammatory response systemic inflammatory response syndrome(SIRS)全身炎症反應全身炎症反應綜合徵--> multiorganic disfuncional syndrome多器官功能障礙綜合徵(MODS)
Hypermetabolic代謝亢進 state with 2 or more inflammatory signs
leukocytosis白細胞增多
hypotension
systemic organic dysfunction 全身性器質功能障礙
tachypnea呼吸急促
leukopenia白細胞減少
fever
special pathogenesis.
neurogen shock神經源性休克
failure in vasomotor
poor blood distribution.
hypovolemic shock低血容量性休克
loss of blood volume
example
hemorrhage 出血
diarrhea
burns
excessive diuresis過度利尿
sweating
traumas
anafilatic shock過敏性
type I hypersensitivity reaction
cardiogenic shock心臟休克
pump failure
example
arrhythmias心律失常
myocarditis心肌炎
AMI
obstructive shocks阻塞性休克
New(more important )
cardiogenic shock心臟休克
pump failure
example
arrhythmias心律失常
myocarditis心肌炎
Acute myocardial infarction(AMI)急性心肌梗塞
hypovolemic shock低血容量性休克
loss of blood volume
example
hemorrhage 出血
diarrhea
burns
excessive diuresis過度利尿
sweating
traumas
distributive shock分配性休克
最小血管中血流的異常分佈導致血液供應不足到身體的組織和器官
即使心臟輸出處於或高於正常水平，它也會發生
obstructive shock阻塞性休克
very decreased cardiac output心輸出量非常低
example
PE(Pulmonary Embolism)肺栓塞
cardia tamponade 心臟壓塞
tension pneumothorax張力性氣胸
與大血管或心臟本身的物理阻塞相關的一種休克形式
Morphology
brain
white and gray matter blurred
heart
become browness color
with strips (tobby heart, myocardial steatosis)
polyluecrphi nulclearfy多見性
kidneys
swelling , can not be differentiate the corticomedullary不能區分皮質髓質聯合
example
turbid swelling
hydropic deg
lungs
cut the lung—> see the foam, and liquid come from the space
line by headline membranes
ex: diffuse alveolar damage (fetal)
瀰漫性肺泡損傷（胎兒）
intestine : ex:ischemic enteritis , intestinal infraction
liver: fat changes ,
pancreas: ex: terminal acute