Shock, Hemorrhage and Thrombosis

Size: px
Start display at page:

Download "Shock, Hemorrhage and Thrombosis"

Transcription

1 Shock, Hemorrhage and Thrombosis 1

2 Shock Systemic hypoperfusion due to: Reduction in cardiac output Reduction in effective circulating blood volume Hypotension Impaired tissue perfusion Cellular hypoxia 5. Anaphylactic -IgE mediated hypersensitivity Spinal cord injury Vascular tone Pooling of blood * high mortality 2

3 3

4 Stages of Shock: Basic Pathology 7/e Non-Progressive Stage Progressive Stage Irreversible Stage -compensatory reflex mechanisms activated (baroreceptors/ catechol. release) -perfusion maintained -tissue hypoperfusion & worsened circulatory metabolic imbalance -severe cell & tissue injury with no chance of recovery 4

5 Significance of Hemorrhage NO CLINICAL FINDINGS: HYPOVOLEMIC SHOCK: 10-20% of bld. vol. lost OR slow blood loss larger blood losses OR more rapid bld. loss Congestion (Hyperemia) Increased volume of blood in affected tissue Mechanism: arterial and arteriolar dilatation bld. flow into capillaries 5

6 6

7 Edema *The abnormal accumulation of fluid in the intercellular tissue spaces or body cavities -localized -systemic 7

8 Edema fluids: nomenclature -abdomen: ascites -pleural cavities: effusions / hydrothorax -pericardium: effusion -total body: anasarca 8

9 Extravascular/Edema Fluids:Terminology Transudate: -low protein content -non-inflammatory -ultrafiltrate of plasma (mostly albumin) -due to osmotic/hydrostatic imbalance -no increase in vasc. permeab.) -S.G. < Exudate: -high protein concentration -inflammatory -due to altered permeab. of small bld. vessels -S.G. >1.020 Mechanisms of edema formation plasma colloid oncotic pressure hydrostatic pressure endothelial permeability lymphatic blockage 9

10 10

11 11

12 Thrombosis: the Virchow triad Endothelial injury Thrombosis Abnormal blood flow hypercoagulability 12

13 13

14 Types & Fate of Thrombi Types Arterial: coronary, cerebral, aorta + branches Venous: 90% in deep leg veins -also peri-uterine, peri-prostatic Mural: heart Fate Venous thrombi ( right-sided) Lungs Propagation Embolization Dissolution Organization and recanalization Arterial thrombi ( left-sided ) Brain Spleen kidneys 14

15 brain Paradoxical embolus: through patent foramen ovale to left side saddle embolus RV Mural thrombus In left ventricle (e.g., after myocardial Infarction & hypokinesis) Atrial appendage thrombi (often in mitral stenosis + atrial fibrillation) mitral valve endocarditis spleen Pulmonary infarct (wedgeshaped region of necrotic lung). Seen in only approx. 10% of pulmonary emboli because of dual lung perfusion from bronchial arteries kidneys Right-sided thromboemboli: Classic example is pulmonary emboli Left-sided thromboemboli: Classic examples are mural thrombi in Left atrium/ventricle or endocarditis 15

16 16

17 Acute myocardial infarction 17

18 18

19 Pulmonary Infarct Disseminated Intravascular Coagulation (DIC) (Consumption Coagulopathy) Widespread thrombosis in microcirculation Platelets & fibrin in capillaries Mechanism: Activate intrinsic pathway Clinical: sepsis obstetrical catastrophe-- cancer extensive tissue damage Hematologic: rapid consumption of fibrinogen, platelets, prothrombin, V, VIII, X Generation of d-dimers ( fibrin split products ) 19

20 Sepsis & Septic shock: definitions 1. SEPSIS: suspected or proven infection 2. SEVERE SEPSIS: sepsis + + systemic inflammatory response syndrome: fever, tachycardia, tachypnea, leukocytosis ORGAN DYSFUNCTION: hypotension, hypoxemia, oliguria, metabolic acidosis, thrombocytopenia, obtundation 3. SEPTIC SHOCK: severe sepsis + ORGAN DYSFUNCTION, HYPOTENSION, despite adequate fluid resuscitation 750,000 cases of sepsis / yr. in U.S. 20

21 sepsis Sources: pneumonia bacteria meningitis inflam. bowel dis. GU tract (urosepsis) Immune cell cross-talk in sepsis NEJM 2003; 348:

22 Toll-like receptors (TLR) Family of PPR s (pattern recognition receptors) TLR2: peptidoglycan Gram+ org s leukocyte TLR 4: LPS (endotoxin) Gram- org s edema vasc. permeab. systemic acutephase response PG s TLR s TNF IL-1 PMN mac Role of innate immune response in sepsis: proinflam. cytokines upregulate adhesion molecules inos NO vasodilation 22

23 B Role of adaptive immune response in sepsis T anti-inflam. shift in sepsis Th1 Th2 PROINFLAM. cytokines: TNF, IL-1 ANTI-INFLAM. cytokines: IL-4, IL-10 Roles of procoagulantanti-coagulant balance PRO anti damage LPS tissue factor (thromboplastin) coagulation fibrin thrombus levels of: Protein C Protein S Antithrombin III Tissue factorpathway inhibitor 23

24 NEJM 2006; 355: Organ Dysfunction in Septic Shock Circulatory shock myocardial contractility NO TNF IL-6 acute lung injury PMN vascular resistance + hypovolemia vasodilation fluid renal failure ( pre-renal ) 24

Hemodynamic Disorders, Thrombosis, and Shock. Richard A. McPherson, M.D.

Hemodynamic Disorders, Thrombosis, and Shock. Richard A. McPherson, M.D. Hemodynamic Disorders, Thrombosis, and Shock Richard A. McPherson, M.D. Edema The accumulation of abnormal amounts of fluid in intercellular spaces of body cavities. Inflammation and release of mediators

More information

Hemodynamic Disorders Thrombosis and Shock. 1. Interstitial, between the cells, but outside of the vascular system. - water making up the blood and

Hemodynamic Disorders Thrombosis and Shock. 1. Interstitial, between the cells, but outside of the vascular system. - water making up the blood and Hemodynamic Disorders Thrombosis and Shock I. Body water, where is it and what keeps it there? A. Intracellular B. Extracellular (intercellular) 1. Interstitial, between the cells, but outside of the vascular

More information

Thrombosis. Dr. László Terézia

Thrombosis. Dr. László Terézia Thrombosis Dr. László Terézia HYPERCOAGULABILITY THROMBOSIS BLOODFLOW ENDOTHEL VIRCHOW ENDOTHEL INJURY L. ventricle: Arteries: surgery infection prosthetic valve hypertension irradiation chemical: cigarette

More information

Disturbance of Circulation Hemodynamic Disorder

Disturbance of Circulation Hemodynamic Disorder Disturbance of Circulation Hemodynamic Disorder 2/17/2017 By Dr. Hemn Hassan Othman PhD, Pathology Fall 2016 1 Thrombosis Definition: Thrombosis is the formation of solid or semisolid blood clot within

More information

Circulatory Disturbances 5: Thrombosis, Embolism, Infarction, Shock

Circulatory Disturbances 5: Thrombosis, Embolism, Infarction, Shock Circulatory Disturbances 5: Thrombosis, Embolism, Infarction, Shock Shannon Martinson, Feb 2016 http://people.upei.ca/smartinson/ VPM 152 General Pathology Thrombosis, Embolism, Infarction, Shock Learning

More information

Thrombosis and emboli. Peter Nagy

Thrombosis and emboli. Peter Nagy Thrombosis and emboli Peter Nagy A thrombus is any solid object developing from the blood in vivo within the vascular system or heart. Thrombosis is hemostasis in the wrong place. Major components, forms:

More information

HEMODYNAMIC DISORDERS

HEMODYNAMIC DISORDERS HEMODYNAMIC DISORDERS Normal fluid homeostasis requires vessel wall integrity as well as maintenance of intravascular pressure and osmolarity within certain physiologic ranges. Increases in vascular volume

More information

Bachelor of Chinese Medicine Shock

Bachelor of Chinese Medicine Shock BCM Year 2 Dr. Irene Ng Jan 28, 2003 9:30 am 1:00 pm Rm 004 UPB Bachelor of Chinese Medicine 2002 2003 Shock Learning objectives Be able to: know the definition of shock know the classification and causes

More information

HYPEREMIA AND CONGESTION

HYPEREMIA AND CONGESTION HYPEREMIA AND CONGESTION Learning Objectives Define congestion and hyperemia Differentiate between the two with regard to: Mechanisms / underlying causes Appearance (gross and histologic) Effects Differentiate

More information

Wheater: Part 1: Thrombosis, embolism and infarction. Laboratory assignment: C601/C602 Histopathology manual, hemodynamic unit.

Wheater: Part 1: Thrombosis, embolism and infarction. Laboratory assignment: C601/C602 Histopathology manual, hemodynamic unit. Pathology C 601 Hemodynamic Derangements Assignment page. Reading: Robbins: Chapter 4 Clinical Lab Source: - Protime (PT) Know about INR - Activated partial thrmboplastin time (APTT) - Activated coagulation

More information

Pathophysiology. Tutorial 3 Hemodynamic Disorders

Pathophysiology. Tutorial 3 Hemodynamic Disorders Pathophysiology Tutorial 3 Hemodynamic Disorders ILOs Recall different causes of thrombosis. Explain different types of embolism and their predisposing factors. Differentiate between hemorrhage types.

More information

-Cardiogenic: shock state resulting from impairment or failure of myocardium

-Cardiogenic: shock state resulting from impairment or failure of myocardium Shock chapter Shock -Condition in which tissue perfusion is inadequate to deliver oxygen, nutrients to support vital organs, cellular function -Affects all body systems -Classic signs of early shock: Tachycardia,tachypnea,restlessness,anxiety,

More information

12/1/2009. Chapter 19: Hemorrhage. Hemorrhage and Shock Occurs when there is a disruption or leak in the vascular system Internal hemorrhage

12/1/2009. Chapter 19: Hemorrhage. Hemorrhage and Shock Occurs when there is a disruption or leak in the vascular system Internal hemorrhage Chapter 19: Hemorrhage Hemorrhage and Shock Occurs when there is a disruption or leak in the vascular system External hemorrhage Internal hemorrhage Associated with higher morbidity and mortality than

More information

Hemodynamic Disorders Thrombosis and Shock

Hemodynamic Disorders Thrombosis and Shock Hemodynamic Disorders Thrombosis and Shock SCPA 202 Basic Pathology Somphong Narkpinit, M.D. Department of Pathobiology, Faculty of Science, Mahidol University Email : somphong.nar@mahidol.ac.th Hemodynamic

More information

1- Thromboembolism. 2- fat embolism. 3- air embolism. 4- amniotic fluid embolism.

1- Thromboembolism. 2- fat embolism. 3- air embolism. 4- amniotic fluid embolism. Embolism Definition:- An embolus is a detached intravascular solid, liquid or gaseous mass that is carried by blood to sites distant from its point of origin. After traveling via the blood, the embolus

More information

THROMBOSIS. Dr. Nisreen Abu Shahin Assistant Professor of Pathology Pathology Department University of Jordan

THROMBOSIS. Dr. Nisreen Abu Shahin Assistant Professor of Pathology Pathology Department University of Jordan THROMBOSIS Dr. Nisreen Abu Shahin Assistant Professor of Pathology Pathology Department University of Jordan NORMAL BLOOD VESSEL HISTOLOGY THROMBOSIS Pathogenesis (called Virchow's triad): 1. Endothelial*

More information

Physiological Response to Hypovolemic Shock Dr Khwaja Mohammed Amir MD Assistant Professor(Physiology) Objectives At the end of the session the

Physiological Response to Hypovolemic Shock Dr Khwaja Mohammed Amir MD Assistant Professor(Physiology) Objectives At the end of the session the Physiological Response to Hypovolemic Shock Dr Khwaja Mohammed Amir MD Assistant Professor(Physiology) Objectives At the end of the session the students should be able to: List causes of shock including

More information

Chapter 4: Haemodynamic disorders, shock

Chapter 4: Haemodynamic disorders, shock Chapter 4: Haemodynamic disorders, shock 1. Regarding platelets (2006) (a) They are the main source of thrombin (b) they number 150-300 x10 3 per microlitre (c) They contain a nucleus (d) They are biconcave

More information

Hyperemia, Congestion, and Edema

Hyperemia, Congestion, and Edema Hyperemia, Congestion, and Edema Hyperemia Acute, actively increased blood flow Tissues look red (erythema) Congestion Chronic, passively reduced outflow Tissues look pale or blue (cyanosis) Edema Water

More information

ATHEROSCLEROSIS. Secondary changes are found in other coats of the vessel wall.

ATHEROSCLEROSIS. Secondary changes are found in other coats of the vessel wall. ATHEROSCLEROSIS Atherosclerosis Atherosclerosis is a disease process affecting the intima of the aorta and large and medium arteries, taking the form of focal thickening or plaques of fibrous tissue and

More information

HEMODYNAMIC DISORDERS. J v = ([Pc Pi] σ[πc πi])

HEMODYNAMIC DISORDERS. J v = ([Pc Pi] σ[πc πi]) HEMODYNAMIC DISORDERS J v = ([Pc Pi] σ[πc πi]) Hemodynamic Disorders Thromboembolic Disease Shock Overview Edema Hyperemia Congestion Hemorrhage Hemostasis Thrombosis Embolism Infarction Shock EDEMA ONLY

More information

Means failure of heart to pump enough blood to satisfy the need of the body.

Means failure of heart to pump enough blood to satisfy the need of the body. Means failure of heart to pump enough blood to satisfy the need of the body. Due to an impaired ability of the heart to adequately to fill or eject blood. HEART FAILURE Heart failure (HF) means decreased

More information

Shock. Shao Mian Emergency Department,Zhongshan Hospital

Shock. Shao Mian Emergency Department,Zhongshan Hospital Shock Shao Mian Emergency Department,Zhongshan Hospital What is shock THE BEGINNINGS OF UNDERSTANDING: THE LATE 19TH CENTURY THE AGE OF REASON: 1890 1925 THE MODERN ERA: BLALOCK S EPIPHANY POSTMODERNISM:

More information

EDEMA. Learning Objectives

EDEMA. Learning Objectives EDEMA Learning Objectives Define edema Recognize and be able to describe the gross and microscopic appearance of edema Know the four pathophysiological mechanisms by which edema develops Understand the

More information

Pediatric Code Blue. Goals of Resuscitation. Focus Conference November Ensure organ perfusion

Pediatric Code Blue. Goals of Resuscitation. Focus Conference November Ensure organ perfusion Pediatric Code Blue Focus Conference November 2015 Duane C. Williams, MD Pediatric Critical Care Department of Pediatrics Children s Hospital of Richmond at VCU Goals of Resuscitation Ensure organ perfusion

More information

Jessica Bryan, Natalia Evans, Karlyn Henderson, & Whitney Parks

Jessica Bryan, Natalia Evans, Karlyn Henderson, & Whitney Parks Jessica Bryan, Natalia Evans, Karlyn Henderson, & Whitney Parks 1. What is the most common cause of death in hospitalized patients? 1. Hospital-acquired infection 2. Pulmonary embolism 3. Myocardial infarction

More information

Circulatory disorders

Circulatory disorders Circulatory disorders Edema = fluid in interstitium transudate s.w.1.012, exudate 1.020) generalized x local prominent cavities hydrothorax, hydropericardium, ascites subcutaneous tissue (pitting edema)

More information

Department of Intensive Care Medicine UNDERSTANDING CIRCULATORY FAILURE IN SEPSIS

Department of Intensive Care Medicine UNDERSTANDING CIRCULATORY FAILURE IN SEPSIS Department of Intensive Care Medicine UNDERSTANDING CIRCULATORY FAILURE IN SEPSIS UNDERSTANDING CIRCULATORY FAILURE IN SEPSIS a mismatch between tissue perfusion and metabolic demands the heart, the vasculature

More information

HEME 10 Bleeding Disorders

HEME 10 Bleeding Disorders HEME 10 Bleeding Disorders When injury occurs, three mechanisms occur Blood vessels Primary hemostasis Secondary hemostasis Diseases of the blood vessels Platelet disorders Thrombocytopenia Functional

More information

SHOCK AETIOLOGY OF SHOCK (1) Inadequate circulating blood volume ) Loss of Autonomic control of the vasculature (3) Impaired cardiac function

SHOCK AETIOLOGY OF SHOCK (1) Inadequate circulating blood volume ) Loss of Autonomic control of the vasculature (3) Impaired cardiac function SHOCK Shock is a condition in which the metabolic needs of the body are not met because of an inadequate cardiac output. If tissue perfusion can be restored in an expeditious fashion, cellular injury may

More information

Disseminated intravascular coagulation (DIC) Dr. Klara Vezendi Szeged University Transfusiology Department

Disseminated intravascular coagulation (DIC) Dr. Klara Vezendi Szeged University Transfusiology Department Disseminated intravascular coagulation (DIC) Dr. Klara Vezendi Szeged University Transfusiology Department Disseminated intravascular coagulation (DIC, consumptive coagulopathy) is a clinicopathologic

More information

5 DISTURBANCES IN CIRCULATION. Congestion / Hyperemia Haemorrhage Thrombosis Embolism Ischemia Infarction Oedema Shock Sludged blood Model Questions

5 DISTURBANCES IN CIRCULATION. Congestion / Hyperemia Haemorrhage Thrombosis Embolism Ischemia Infarction Oedema Shock Sludged blood Model Questions 5 DISTURBANCES IN CIRCULATION Congestion / Hyperemia Haemorrhage Thrombosis Embolism Ischemia Infarction Oedema Shock Sludged blood Model Questions CONGESTION/ HYPEREMIA Hyperemia is increased amount of

More information

Hemodynamic derangement. Komson Wannasai, M.D.,FRCPath. Department of Pathology Faculty of Medicine Chiang Mai University

Hemodynamic derangement. Komson Wannasai, M.D.,FRCPath. Department of Pathology Faculty of Medicine Chiang Mai University Hemodynamic derangement Komson Wannasai, M.D.,FRCPath. Department of Pathology Faculty of Medicine Chiang Mai University Objective The students should be able to Explain normal body fluid homeostasis Explain

More information

Thrombosis (lec#1) * Pathogenesis (called Virchow's triad ): Endothelial Injury Stasis Blood Hypercoagulability. stimulated Stasis:

Thrombosis (lec#1) * Pathogenesis (called Virchow's triad ): Endothelial Injury Stasis Blood Hypercoagulability. stimulated Stasis: Thrombosis (lec#1) * Pathogenesis (called Virchow's triad): Endothelial Injury ( Heart, Arteries), Stasis (abnormal blood flow),blood Hypercoagulability. * Endothelial cells can be stimulated by direct

More information

SPECIAL PATHOPHYSIOLOGY SHOCK

SPECIAL PATHOPHYSIOLOGY SHOCK SPECIAL PATHOPHYSIOLOGY SHOCK 1. How do we call blood pressure values below the reference range? 1.Hypovolemia. 2. Hypothermia. 3. Hypooncia. 4. Hypoosmia. 5. Hypotension. 2. What is acute circulatory

More information

Hemodynamic Disorders, Thromboembolic Disease, and Shock

Hemodynamic Disorders, Thromboembolic Disease, and Shock Hemodynamic Disorders, Thromboembolic Disease, and Shock Kumar et al: Robbins & Cotran Pathologic Basis of Disease 7E Figure 4-1 Factors affecting fluid balance across capillary walls. Capillary hydrostatic

More information

Shock Management. Seyed Tayeb Moradian MSc, Critical Care Nursing Ph.D Candidate. PDF created with pdffactory Pro trial version

Shock Management. Seyed Tayeb Moradian MSc, Critical Care Nursing Ph.D Candidate. PDF created with pdffactory Pro trial version Shock Management Seyed Tayeb Moradian MSc, Critical Care Nursing Ph.D Candidate Definition of Shock The definition of shock does not involve low blood pressure, rapid pulse or cool clammy skin - these

More information

Ischaemia It means local anemia, it is characterized by a decrease amount of blood in an organ or region. Causes of Ischemia: *1.

Ischaemia It means local anemia, it is characterized by a decrease amount of blood in an organ or region. Causes of Ischemia: *1. المرحلة الثالثة م. هالة عباس ناجي Ischaemia It means local anemia, it is characterized by a decrease amount of blood in an organ or region. Causes of Ischemia: *1.External pressure upon an artery e.g:

More information

Hypovolemic Shock: Regulation of Blood Pressure

Hypovolemic Shock: Regulation of Blood Pressure CARDIOVASCULAR PHYSIOLOGY 81 Case 15 Hypovolemic Shock: Regulation of Blood Pressure Mavis Byrne is a 78-year-old widow who was brought to the emergency room one evening by her sister. Early in the day,

More information

What would be the response of the sympathetic system to this patient s decrease in arterial pressure?

What would be the response of the sympathetic system to this patient s decrease in arterial pressure? CASE 51 A 62-year-old man undergoes surgery to correct a herniated disc in his spine. The patient is thought to have an uncomplicated surgery until he complains of extreme abdominal distention and pain

More information

Sepsis and Shock States

Sepsis and Shock States Sepsis and Shock States Presented By: Cynthia Webner BSN, RN, CCRN, CMC www.cardionursing.com CNEA 2009 1 INFECTION Inflammatory response to microorganisms, or Invasion of normally sterile tissues SYSTEMIC

More information

Circulatory Disturbances 1: Introduction and Edema

Circulatory Disturbances 1: Introduction and Edema Circulatory Disturbances 1: Introduction and Edema Shannon Martinson, January 2016 http://people.upei.ca/smartinson/ VPM 152 General Pathology INTRODUCTION NORMAL CIRCULATORY SYSTEM Important concepts

More information

Dr. Rami M. Adil Al-Hayali Assistant Professor in Medicine

Dr. Rami M. Adil Al-Hayali Assistant Professor in Medicine Dr. Rami M. Adil Al-Hayali Assistant Professor in Medicine Venous thromboembolism: pulmonary embolism (PE) deep vein thrombosis (DVT) 1% of all patients admitted to hospital 5% of in-hospital mortality

More information

Pathophysiology of Catheter-Related Infection. All sources of infection are potential targets for prevention. Infusates/ drugs. hub/lines Dressing

Pathophysiology of Catheter-Related Infection. All sources of infection are potential targets for prevention. Infusates/ drugs. hub/lines Dressing Pathophysiology of Catheter-Related Infection All sources of infection are potential targets for prevention catheter hematogeneous Infusates/ drugs hub/lines Dressing skin Critically ill patient: 2-4 vascular

More information

PE and DVT. Dr Anzo William Adiga WatsApp or Call Medical Officer/RHEMA MEDICAL GROUP

PE and DVT. Dr Anzo William Adiga WatsApp or Call Medical Officer/RHEMA MEDICAL GROUP PE and DVT Dr Anzo William Adiga WatsApp or Call +256777363201 Medical Officer/RHEMA MEDICAL GROUP OBJECTIVES DEFINE DVT AND P.E PATHOPHYSIOLOGY OF DVT CLINICAL PRESENTATION OF DVT/PE INVESTIGATE DVT MANAGEMENT

More information

Pulmonary Embolism. Thoracic radiologist Helena Lauri

Pulmonary Embolism. Thoracic radiologist Helena Lauri Pulmonary Embolism Thoracic radiologist Helena Lauri 8.5.2017 Statistics 1-2 out of 1000 adults annually are diagnosed with deep vein thrombosis (DVT) and/or pulmonary embolism (PE) About half of patients

More information

Hemodynamic Disorders, Thromboembolic Disease and Shock (part 1)

Hemodynamic Disorders, Thromboembolic Disease and Shock (part 1) Hemodynamic Disorders, Thromboembolic Disease and Shock (part 1) Lilla Madaras Semmelweis University 2 nd Department of Pathology 17 th September 2018 1 Normal fluid homeostasis Vessel wall integrity Intravascular

More information

How to maintain optimal perfusion during Cardiopulmonary By-pass. Herdono Poernomo, MD

How to maintain optimal perfusion during Cardiopulmonary By-pass. Herdono Poernomo, MD How to maintain optimal perfusion during Cardiopulmonary By-pass Herdono Poernomo, MD Cardiopulmonary By-pass Target Physiologic condition as a healthy person Everything is in Normal Limit How to maintain

More information

Thromboembolismand Shock 血管栓塞和休克

Thromboembolismand Shock 血管栓塞和休克 Thromboembolismand Shock 血管栓塞和休克 Major Hemodynamic Disorders Edema Hypermia and Congestion 充血 Haemorrhage Hemostasis 止血 and Blood Coagulation 血液凝固 Thrombosis 血栓形成 Embolism 栓塞 Infarction 梗死 Disseminated

More information

Cardiovascular Disorders. Heart Disorders. Diagnostic Tests for CV Function. Bio 375. Pathophysiology

Cardiovascular Disorders. Heart Disorders. Diagnostic Tests for CV Function. Bio 375. Pathophysiology Cardiovascular Disorders Bio 375 Pathophysiology Heart Disorders Heart disease is ranked as a major cause of death in the U.S. Common heart diseases include: Congenital heart defects Hypertensive heart

More information

What are blood clots?

What are blood clots? What are blood clots? Dr Matthew Fay GP Principal The Willows Medical Practice- Queensbury GPwSI and Co-Founder Westcliffe Cardiology Service GP Partner Westcliffe Medical Group Created 5/31/18 Dr. Matthew

More information

CARDIOGENIC SHOCK. Antonio Pesenti. Università degli Studi di Milano Bicocca Azienda Ospedaliera San Gerardo Monza (MI)

CARDIOGENIC SHOCK. Antonio Pesenti. Università degli Studi di Milano Bicocca Azienda Ospedaliera San Gerardo Monza (MI) CARDIOGENIC SHOCK Antonio Pesenti Università degli Studi di Milano Bicocca Azienda Ospedaliera San Gerardo Monza (MI) Primary myocardial dysfunction resulting in the inability of the heart to mantain an

More information

Hemodynamic Disorder and cardiovascular diseases. 台北醫學大學病理學科 林永和

Hemodynamic Disorder and cardiovascular diseases. 台北醫學大學病理學科 林永和 Hemodynamic Disorder and cardiovascular diseases 台北醫學大學病理學科 林永和 kevinyhl@tmu.edu.tw (A) Hemodynamic Disorder Edema hyperemia or congestion hemorrhage thrombosis embolism infarction shock Edema an excess

More information

Circulatory shock. Types, Etiology, Pathophysiology. Physiology of Circulation: The Vessels. 600,000 miles of vessels containing 5-6 liters of blood

Circulatory shock. Types, Etiology, Pathophysiology. Physiology of Circulation: The Vessels. 600,000 miles of vessels containing 5-6 liters of blood Circulatory shock Types, Etiology, Pathophysiology Blagoi Marinov, MD, PhD Pathophysiology Dept. Physiology of Circulation: The Vessels 600,000 miles of vessels containing 5-6 liters of blood Vessel tone

More information

Proceeding of the LAVECCS

Proceeding of the LAVECCS Close this window to return to IVIS Proceeding of the LAVECCS Congreso Latinoamericano de Emergencia y Cuidados Intensivos Ju1. 28-30, 2011 Santiago de Chile, Chile www.laveccs.org Reprinted in IVIS with

More information

Definition. Emergency Treatment 11/13/13. Pathophysiology of circulatory shock. Characteristics of circulatory shock. Clinical features of shock

Definition. Emergency Treatment 11/13/13. Pathophysiology of circulatory shock. Characteristics of circulatory shock. Clinical features of shock Definition Pathophysiology of circulatory shock! Inadequate perfusion (oxygen supply) of tissues, resulting in:! Organ dysfunction! Cellular and organ damage And if not quickly corrected! Death Dr Badri

More information

Lung diseases of Vascular Origin. By: Shefaa Qa qqa

Lung diseases of Vascular Origin. By: Shefaa Qa qqa Lung diseases of Vascular Origin By: Shefaa Qa qqa Pulmonary Hypertension Pulmonary hypertension is defined as a mean pulmonary artery pressure greater than or equal to 25 mm Hg at rest. Based on underlying

More information

Online Supplementary Data. Country Number of centers Number of patients randomized

Online Supplementary Data. Country Number of centers Number of patients randomized A Randomized, Double-Blind, -Controlled, Phase-2B Study to Evaluate the Safety and Efficacy of Recombinant Human Soluble Thrombomodulin, ART-123, in Patients with Sepsis and Suspected Disseminated Intravascular

More information

Disseminated Intravascular Coagulation (DIC) Seminar. Ron Kopilov 4 th year Medical Student, Tel Aviv University Internal Medicine A 8.3.

Disseminated Intravascular Coagulation (DIC) Seminar. Ron Kopilov 4 th year Medical Student, Tel Aviv University Internal Medicine A 8.3. Disseminated Intravascular Coagulation (DIC) Seminar Ron Kopilov 4 th year Medical Student, Tel Aviv University Internal Medicine A 8.3.2012 1 Our plan: Understand the pathophysiology Identify risk factors

More information

Case year old female nursing home resident with a hx CAD, PUD, recent hip fracture Transferred to ED with decreased mental status BP in ED 80/50

Case year old female nursing home resident with a hx CAD, PUD, recent hip fracture Transferred to ED with decreased mental status BP in ED 80/50 Case 1 65 year old female nursing home resident with a hx CAD, PUD, recent hip fracture Transferred to ED with decreased mental status BP in ED 80/50 Case 1 65 year old female nursing home resident with

More information

Cardiovascular System

Cardiovascular System Cardiovascular System 1 The Heart Major organ of the cardiovascular system 2 What is the mediastinum? The mediastinum is the space between the lungs, where the heart is located. The heart is divided into

More information

Pathologic Mechanisms of Septic Shock

Pathologic Mechanisms of Septic Shock Pathologic Mechanisms of Septic Shock Kenneth J. Goodrum, Ph.D. Dept. Biomedical Sciences Ohio University College of Osteopathic Medicine Outline of Topics Definitions: SIRS, sepsis, shock, MODS Morbidity/mortality

More information

Written 01/09/17 Rewritten 3/29/17 for Interior Regional EMS Symposium

Written 01/09/17 Rewritten 3/29/17 for Interior Regional EMS Symposium Written 01/09/17 Rewritten 3/29/17 for Interior Regional EMS Symposium MARIA E. MANDICH MD Fairbanks Memorial Hospital Emergency Department Attending Physician Interior Region EMS Council Medical Director

More information

P215 SPRING 2019: CIRCULATORY SYSTEM Chaps 13, 14 & 15: pp , , , I. Major Functions of the Circulatory System

P215 SPRING 2019: CIRCULATORY SYSTEM Chaps 13, 14 & 15: pp , , , I. Major Functions of the Circulatory System P215 SPRING 2019: CIRCULATORY SYSTEM Chaps 13, 14 & 15: pp 360-390, 395-404, 410-428 433-438, 441-445 I. Major Functions of the Circulatory System 1. 2. 3. 4. II. Structure of the Heart 1. atria 2. ventricles

More information

Cardiovascular System B L O O D V E S S E L S 3

Cardiovascular System B L O O D V E S S E L S 3 Cardiovascular System B L O O D V E S S E L S 3 Fluid Shifts Between Capillaries and Tissue Permeable capillaries allow plasma and solutes to pass into interstitial space interstitial or extracellular

More information

CrackCast Episode 6 Shock

CrackCast Episode 6 Shock CrackCast Episode 6 Shock Episode overview: 1) List, define and explain the 5 causes of shock 2) What is the utility of lactate and base deficit in the management of shock? 3) Define: SIRS, Sepsis, Severe

More information

Physiology #14. Heart Failure & Circulatory Shock. Mohammad Ja far Tuesday 5/4/2016. Turquoise Team. Page 0 of 13

Physiology #14. Heart Failure & Circulatory Shock. Mohammad Ja far Tuesday 5/4/2016. Turquoise Team. Page 0 of 13 45 Physiology #14 Heart Failure & Circulatory Shock Mohammad Ja far Tuesday 5/4/2016 Turquoise Team Page 0 of 13 Heart Failure: It s a condition in which the heart can t perform its function properly;

More information

Chapter 19. Hemostasis

Chapter 19. Hemostasis Chapter 19 Hemostasis Hemostasis Hemostasis is the cessation of bleeding stopping potentially fatal leaks important in small blood vessels not effective in hemorrhage excessive bleeding from large blood

More information

Pathology of pulmonary vascular disease. Dr.Ashraf Abdelfatah Deyab. Assistant Professor of Pathology Faculty of Medicine Almajma ah University

Pathology of pulmonary vascular disease. Dr.Ashraf Abdelfatah Deyab. Assistant Professor of Pathology Faculty of Medicine Almajma ah University Pathology of pulmonary vascular disease Dr.Ashraf Abdelfatah Deyab Assistant Professor of Pathology Faculty of Medicine Almajma ah University Pulmonary vascular disease Type of pulmonary circulation: Types

More information

BIPN100 F15 Human Physiol I (Kristan) Lecture 14 Cardiovascular control mechanisms p. 1

BIPN100 F15 Human Physiol I (Kristan) Lecture 14 Cardiovascular control mechanisms p. 1 BIPN100 F15 Human Physiol I (Kristan) Lecture 14 Cardiovascular control mechanisms p. 1 Terms you should understand: hemorrhage, intrinsic and extrinsic mechanisms, anoxia, myocardial contractility, residual

More information

Ischemic heart disease

Ischemic heart disease Ischemic heart disease Introduction In > 90% of cases: the cause is: reduced coronary blood flow secondary to: obstructive atherosclerotic vascular disease so most of the time it is called: coronary artery

More information

Heart disease remains the leading cause of morbidity and mortality in industrialized nations. It accounts for nearly 40% of all deaths in the United

Heart disease remains the leading cause of morbidity and mortality in industrialized nations. It accounts for nearly 40% of all deaths in the United Heart disease remains the leading cause of morbidity and mortality in industrialized nations. It accounts for nearly 40% of all deaths in the United States, totaling about 750,000 individuals annually

More information

SEPSIS AND SEPTICEMIA St. Charles Bend / Dec. 18, 2015

SEPSIS AND SEPTICEMIA St. Charles Bend / Dec. 18, 2015 SEPSIS AND SEPTICEMIA St. Charles Bend / Dec. 18, 2015 DEFINITIONS SYSTEMIC INFLAMMATORY RESPONSE SYNDROME SEPSIS SEVERE SEPSIS SEPTIC SHOCK MULTIPLE ORGAN FAILURE BACTEREMIA SEPTICEMIA THOMAS C CESARIO

More information

Nitroglycerin and Heparin Drip Interfacility Protocols

Nitroglycerin and Heparin Drip Interfacility Protocols Nitroglycerin and Heparin Drip Interfacility Protocols EMS Protocol This protocol applies to nitroglycerin and Heparin drips that are initiated at the transferring facility prior to transport and are not

More information

Chapter 3 Disorder of Local Blood Circulation

Chapter 3 Disorder of Local Blood Circulation Chapter 3 Disorder of Local Blood Circulation Disorder of Circulation Disorder of vascular flow may be divided into general and local categories. The local disorders contain: 1Derangement of local blood

More information

Cardiac Pathology & Rehabilitation

Cardiac Pathology & Rehabilitation Cardiac Pathology & Rehabilitation Which of the following best describes the physical activity performed in my leisure time? A. I perform vigorous physical activity 3X/week for 20 minutes each time B.

More information

MESENTERIC ISCHEMIA THE FORGOTTEN DIAGNOSIS. Richard M. Gore, MD North Shore University Health System University of Chicago Evanston, Illinois

MESENTERIC ISCHEMIA THE FORGOTTEN DIAGNOSIS. Richard M. Gore, MD North Shore University Health System University of Chicago Evanston, Illinois MESENTERIC ISCHEMIA THE FORGOTTEN DIAGNOSIS Richard M. Gore, MD North Shore University Health System University of Chicago Evanston, Illinois SCBT/MR 2010 San Diego, California March 8, 2010 16:00-16:10

More information

Shock Quiz! By Clare Di Bona

Shock Quiz! By Clare Di Bona Shock Quiz! By Clare Di Bona Test Question What is Mr Burns full legal name? Answer Charles Montgomery Plantagenet Schicklgruber Burns. (Season 22, episode 11) Question 1. What is the definition of shock?

More information

BUSINESS. Articles? Grades Midterm Review session

BUSINESS. Articles? Grades Midterm Review session BUSINESS Articles? Grades Midterm Review session REVIEW Cardiac cells Myogenic cells Properties of contractile cells CONDUCTION SYSTEM OF THE HEART Conduction pathway SA node (pacemaker) atrial depolarization

More information

Sepsis and Septicemia: Clear up Coding and Documentation Confusion october 2009

Sepsis and Septicemia: Clear up Coding and Documentation Confusion october 2009 Sepsis and Septicemia: Clear Up Coding and Documentation Confusion W h i t e p a p e r Sepsis. Severe sepsis. SIRS. Septicemia. Unfortunately, this isn t a case of tomato, tomahto. Coders and physicians

More information

Tissue oxygenation is dependent upon, cardiac output, hemoglobin saturation and peripheral micro circulation.

Tissue oxygenation is dependent upon, cardiac output, hemoglobin saturation and peripheral micro circulation. Editorial Shock occurs when there is circulatory failure that results in inadequate cellular oxygen, that is arterial blood flow is inadequate to meet tissue metabolic needs. Tissue oxygenation is dependent

More information

SHOCK. May 12, 2011 Body and Disease

SHOCK. May 12, 2011 Body and Disease SHOCK May 12, 2011 Body and Disease Shock Definition of shock Pathophysiology Types of shock Management of shock Shock Definition? Shock What the Duke Community would have experienced if Gordon Hayward

More information

SHOCK Susanna Hilda Hutajulu, MD, PhD

SHOCK Susanna Hilda Hutajulu, MD, PhD SHOCK Susanna Hilda Hutajulu, MD, PhD Div Hematology and Medical Oncology Department of Internal Medicine Universitas Gadjah Mada Yogyakarta Outline Definition Epidemiology Physiology Classes of Shock

More information

Case Scenario 3: Shock and Sepsis

Case Scenario 3: Shock and Sepsis Name: Molly Boyle 1. Define the term shock (Lewis textbook): Shock is a syndrome characterized by decreased perfusion and impaired metabolism. Shock can have a number of causes that result in damage to

More information

Emergency Medical Training Services Emergency Medical Technician Basic Program Outlines Outline Topic: Shock Revised: 11/2013

Emergency Medical Training Services Emergency Medical Technician Basic Program Outlines Outline Topic: Shock Revised: 11/2013 Emergency Medical Training Services Emergency Medical Technician Basic Program Outlines Outline Topic: Shock Revised: 11/2013 DEFINITIONS Aerobic metabolism is energy using oxygen into cells. Anaerobic

More information

10. Thick deposits of lipids on the walls of blood vessels, called, can lead to serious circulatory issues. A. aneurysm B. atherosclerosis C.

10. Thick deposits of lipids on the walls of blood vessels, called, can lead to serious circulatory issues. A. aneurysm B. atherosclerosis C. Heart Student: 1. carry blood away from the heart. A. Arteries B. Veins C. Capillaries 2. What is the leading cause of heart attack and stroke in North America? A. alcohol B. smoking C. arteriosclerosis

More information

The Pharmacology of Hypotension: Vasopressor Choices for HIE patients. Keliana O Mara, PharmD August 4, 2018

The Pharmacology of Hypotension: Vasopressor Choices for HIE patients. Keliana O Mara, PharmD August 4, 2018 The Pharmacology of Hypotension: Vasopressor Choices for HIE patients Keliana O Mara, PharmD August 4, 2018 Objectives Review the pathophysiology of hypotension in neonates Discuss the role of vasopressors

More information

Thrombosis. Jeffrey Jhang, M.D.

Thrombosis. Jeffrey Jhang, M.D. Thrombosis Jeffrey Jhang, M.D. Introduction The human hemostatic system has evolved to maintain blood flow under normal physiologic conditions while remaining primed to rapidly respond to vascular injury

More information

Haemodynamic Disorders

Haemodynamic Disorders Haemodynamic Disorders ZHANG WEI 张伟 Ph.D., A.P. Institute of Pathology & Forensic Medicine Department of Pathology & Patho-physiology Zhejiang University School of Medicine Email:zwei72@zju.edu.cn Thrombosis

More information

Blood Vessels. Chapter 20

Blood Vessels. Chapter 20 Blood Vessels Chapter 20 Summary of the Characteristics of Arteries and Veins Characteristic Artery Vein Wall thickness thick thin Shape in cross section round flattened Thickest tunic media externa Collagen

More information

Bleeding and Shock. Circulatory System

Bleeding and Shock. Circulatory System Bleeding and Shock Aaron J. Katz, AEMT-P, CIC www.es26medic.net 2013 Circulatory System Composed of heart, blood vessels and blood A closed system Pumps oxygenated blood and nutrients to body tissues Delivers

More information

How to Diagnose Heart Failure

How to Diagnose Heart Failure How to Diagnose Heart Failure Patrick J Gallagher 12 th November 2014 Sudden Cardiac Death Davies Criteria 1. Acute coronary event ± infarction 2. Coronary narrowing + healed infarction 3. Coronary narrowing

More information

b) List the steps that may occur in hemostasis with a brief explanation of what happens in those steps.

b) List the steps that may occur in hemostasis with a brief explanation of what happens in those steps. UNIT 6: CARDIOVASCULAR SYSTEM 1) List the three general functions of BLOOD. REVIEW QUESTIONS Blood 2) a) What are the three formed elements /cellular elements in blood (use anatomy vocabulary)? b) List

More information

Unrestricted. Dr ppooransari fellowship of perenatalogy

Unrestricted. Dr ppooransari fellowship of perenatalogy Unrestricted Dr ppooransari fellowship of perenatalogy Assessment of severity of hemorrhage Significant drops in blood pressure are generally not manifested until substantial bleeding has occurred, and

More information

Index. Note: Page numbers of article titles are in boldface type.

Index. Note: Page numbers of article titles are in boldface type. Index Note: Page numbers of article titles are in boldface type. A Acute coronary syndrome(s), anticoagulant therapy in, 706, 707 antiplatelet therapy in, 702 ß-blockers in, 703 cardiac biomarkers in,

More information

Supplementary Appendix

Supplementary Appendix Supplementary Appendix This appendix has been provided by the authors to give readers additional information about their work. Supplement to: Sprung CL, Annane D, Keh D, et al. Hydrocortisone therapy for

More information

HEART HEALTH WEEK 2 SUPPLEMENT. A Beginner s Guide to Cardiovascular Disease ATHEROSCLEROSIS. Fatty deposits can narrow and harden the artery

HEART HEALTH WEEK 2 SUPPLEMENT. A Beginner s Guide to Cardiovascular Disease ATHEROSCLEROSIS. Fatty deposits can narrow and harden the artery WEEK 2 SUPPLEMENT HEART HEALTH A Beginner s Guide to Cardiovascular Disease ATHEROSCLEROSIS FIGURE 1 Atherosclerosis is an inflammatory process where cholesterol is deposited in the wall of arteries and

More information

CIRCULATORY DISTURBANCES

CIRCULATORY DISTURBANCES CIRCULATORY DISTURBANCES Shannon Martinson, January 2016 Email: smartinson@upei.ca All lecture notes and slide shows are available online: http://people.upei.ca/smartinson Office: 418N REFERENCE TEXTS:

More information

Aneurysms & a Brief Discussion on Embolism

Aneurysms & a Brief Discussion on Embolism Aneurysms & a Brief Discussion on Embolism Aneurysms, overview = congenital or acquired dilations of blood vessels or the heart True aneurysms -involve all three layers of the artery (intima, media, and

More information