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Cardiogenic shock with multiple organ dysfunction
Complications of cardiogenic shock
Complications of cardiogenic shock
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There is a variety of different types of shock and each type can be caused by many different things. “Shock is classified as cardiogenic (caused by heart failure); neurogenic or vasogenic (caused by alterations in vascular smooth muscle tone); anaphylactic (caused by hypersensitivity); septic (caused by infection); or hypovolemic (caused by insufficient intravascular fluid volume)” (Huether, McCance, 2010, pp.1696-1697). There is also traumatic shock which is similar to hypovolemic shock and septic shock. Each case of shock is important and needs to be monitored carefully. One type of shock to consider is neurogenic shock.
Neurogenic shock is often referred to as vasogenic shock. This type of shock generally occurs from an imbalance of stimulation of vascular smooth muscle. “Neurogenic shock can be caused by any factor that stimulates parasympathetic activity or inhibits sympathetic activity of vascular smooth muscle” (Huether, McCance, 2010, pp. 1702). One of the factors that can cause neurogenic shock is trauma to the spinal cord. For example, a man named John Jackson suffered a spinal cord injury after being involved in a motorcycle accident; he will likely suffer from neurogenic shock as well. While he is in neurogenic shock however, he has not lost any fluid from vasculature. This is possible because when the spinal cord is injured there can also be injury to the nerve that controls the blood vessels width (Shock, 2013). This leads to a drop in blood pressure because the blood vessels relax and expand, thus leading to a lack of loss of fluid from vasculature. Even though the individual is in neurogenic shock, the type of injury that is causing the shock can alter what the patient is experiencing. A patient that has a diff...
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Huether, S. E., & McCance, K. L. (2010). Pathophysiology- The Biologic Basis for Disease in Adults and Children (sixth ed., pp. 1696-1727). Maryland Heights, MO: Mosby Elsevier.
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Sepsis is a problem of bacterial, parasitic and fungal infections. Due to this, the body develops a systemic immune response to get rid of the infection or tissue damage. This causes inflammation throughout the body, mainly found in small blood vessels or it leads to septicaemia which is where microbes or infections are found in the blood; this can also be called blood poisoning. Septic shock is a life-threatening condition where hypotension occurs as blood pressure drops to a dangerously low level after an infection. In septic shock the patient may experience tachyeordia, this is where there is a greater heart beat than normal (90 heart beats a minute) and tachypnae where the patient is breathing faster than the normal rate (12-20 breathes per minute).
The guidelines’ first focus is the definition of sepsis, which makes sense, because there is no way to effectively treat sepsis without an accurate and categorical definition of the term. The guidelines define sepsis as “the presence (probable or documented) of infection together with systemic manifestations of infection”. Such systemic manifestations can include fever, tachypnea, AMS, WBC >12k, among others; these manifestations are listed in full in Table 1 of the guidelines. The definition for severe sepsis builds on to the definition of sepsis, bringing organ dysfunction and tissue hypoperfusion (oliguria, hypotension, elevated lactate) into the picture; full diagnostic criteria is listed in Table 2. The guidelines recommend that all
Porth, C. (2005). Pathophysiology: concepts of altered health states (8th ed.). Philadelphia: Lippincott Williams & Wilkins.
Chronic Wasting Disease is a highly transmissible, deadly neurodegenerative disease that affects cervids in North America (Belay et al., 2004; Saunders et al., 2012). There are only four types of cervid that are known to get this disease which include elk, mule deer, white-tailed deer, and moose (Chronic Wasting Disease Alliance). It has been classified has a transmissible spongiform encephalopathy (TSE), otherwise known as a prion disease (Belay et al., 2004). A prion is an irregular, pathogenic agent that causes abnormal folding of specific proteins called prion proteins. These proteins are mostly located in the brain (Chronic Wasting Disease Alliance). The abnormal folding of this protein causes neurodegenerative diseases in a variety of species including humans, sheep, cattle, and deer (Abrams et al., 2011).
Huether, S.E. & McCance, K.L. (2008). Understanding pathophysiology (4th ed.). St. Philadelphia, PA: Mosby Elsevier
Jones, Edgar, Nicola T. Fear, and Simon Wessely. "Shell Shock and Mild Traumatic Brain Injury: A Historical Review." The American Journal of Psychiatry 164.11 (2007): 1641-5. http://0-search.proquest.com.library.francis.edu/docview/220510935/fulltextPDF/134DFDDE4904573C8F8/1?accountid=4216 (accessed January 23, 2012).
warm) in the left upper and lower extremities; decreased strength and movement of the right upper and lower extremities and of the left abdominal muscles; lack of triceps and biceps reflexes in the right upper extremity; atypical response of patellar, Achilles (hyper) reflexes in the right lower extremity; abnormal cremasteric reflex in the right groin; fracture in cervical vertebrae #7; and significant swelling in the C7-T12 region of the spinal canal (Signs and symptoms, n.d.). The objective complaint of a severe headache could also be consistent with a spinal cord injury (Headache, nausea, and vomiting,
Two treatment types are being studied for spinal cord injury: injection of an antagonist of the ATP-sensitive receptor P2X7 and transplantation of human embryonic stem cell derived oligodendrocyte progenitor cells. In the spinal cord, ATP can act as an excitatory neurotransmitter (Domercq et al,. 2009). ATP is released in excess for six hours after the initial damage. Most tissue damage happens after the main injury occurs, so finding a treatment that will slow the secondary injury down is a main interest for clinical treatment studies. Injecting a P2X7 antagonist that is sensitive to ATP into the region of the spinal cord that has been damaged has been found to slow down secondary injury (Peng et al., 2009). Also, demyelination of neurons can be found after spinal cord injury. Transplanting human embryonic stem cell derived oligodendrocyte progenitor cells into the damaged tissue has shown to help with remyelinating the neurons. Th...
Sepsis is defined as an exaggerated, overwhelming and uncontrolled systemic inflammatory response to an initially localised infection or tissue injury, which may lead to severe sepsis and septic shock if left untreated (Daniels, 2009; Robson & Daniels, 2013; Dellinger et al, 2013; Perman, Goyal & Gaieski, 2012; Vanzant & Schmelzer, 2011). Septic shock can be classified by acute circulatory failure as a result of massive vasodilation, increased capillary permeability and decreased vascular resistance in the body, causing refractory hypotension despite adequate fluid resuscitation. This leads to irreversible tissue ischaemia, end organ failure and ultimately, death (McClelland & Moxon, 2014; Sagy, Al-Qaqaa & Kim, 2013, Dellinger et al, 2013).
U.S. National Library of Medicine, 26 Sept. 2011. Web. The Web. The Web. 19 Nov. 2013.
Porth, C. (2009). Pathophysiology: Concepts of Altered Health States (8th ed.). Philadelphia: Lippincott, Williams & Wilkins.
... Medicine. 3rd ed. Vol.3. Detroit: Gale, 2006.2139-2141. Gale Virtual Reference Library. Web. 3 Apr. 2014.
The current patient may be experiencing a range of traumatic injuries after his accident, the injuries that the paramedic will focus on are those that are most life threatening. These injuries include: a possible tension pneumothroax or a haemothorax, hypovolemic shock, a mild or stable pelvic fracture and tibia fibula fracture. A pneumothorax is defined as “the presence of air or gas in the plural cavity which can impair oxygenation and/or ventilation” (Daley, 2014). The development of a pneumothorax to a tension pneumothorax can be caused from positive pressure ventilation.
Ed. David Zieve. U.S. National Library of Medicine, 26 Feb. 2014. Web. The Web.