Case study 1 A young man is brought to the emergency department by am artment by
ID: 3520759 • Letter: C
Question
Case study 1 A young man is brought to the emergency department by am artment by ambulance on the His blood pressure next day after a severe traffic accident. He is unconscious is 78/48 mmHg, heart rate 130 beats per minute. There is no evid trauma. T he pupils are 2mm and reactive. He withdraws to pain. Cardiac examination reveals no murmurs, gallops or rubs The lungs are clear to auscultation. The abdomen is tense, with decreas patient shows cyanosis, with thread pulses. rQuestions] (1) What are the three major pathophysiologic causes of shoc likely in this patient? Why? (2) What changes in microcirculation? Which was likely in this patient? Why? nt are the three general stages of shock according to the differe (3) What pathogenetic mechanism accounts for this patient's unresponsiveness and cyanosis? (4) What therapeutic measures are essential for this patient?Explanation / Answer
Ans. The major pathophysiological causes of shock such as hypovolumic shock, cardiogenic shock and obstructive shock
(2) What are the three general stages ……….
Ans. Stage I Non progressive (compensatory phase ): During this stage of shock, neuro humoral mechanisms help to maintain cardiac output and blood pressure. These include baroreceptor reflexes, release of catecholamines, activation of renin-angiotensin system, and antidiuretic hormone secretion.
Stage II progressive (de- compensatory phase): If compensatory mechanisms fail to prevent circulatory insufficiency then there is a rapid pulse, further lowering of blood pressure, respiratory difficulties, low urine output, metabolic acidosis.
Stage III Irreverssible: The patient deteriorates due to failure of the compensatory mechanisms. There is so severe cellular and tissue injury that death occur even if the haemodynamic defects are corrected eg. myocardial ischaemia cell necrosis
(4) what therapeutic …….
Ans. There are four phases of the treatment of shock and therapeutic goals and monitoring need to be adapted to each phase