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Emergency states

This lecture presentation by Professor Pirozhkov S.V. covers the topic of collapse, including its types, origins, and classifications. It also delves into the concept of shock, adaptive reactions, and the irreversible changes that occur in progressing shock. Furthermore, the presentation explores the types of distributive shock and the deterioration of heart function in shock. Lastly, it discusses the most common causes of coma.

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Emergency states

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  1. The State Education Institution of Higher Professional Training The First Sechenov Moscow State Medical University under Ministry of Health of the Russian Federation Department of Pathophysiology Emergency states Lecture presentation Professor Pirozhkov S.V. 2014-2015 education year

  2. Collapse– acute severe decrease in systemic blood pressure due to rapidly developing incongruity between the volume of circulating blood and the capacity of the vascular bed

  3. TYPESOF COLLAPSEBY ORIGIN cardiogenic hypovolemic ● postinfarction ● arrhythmic ● cardiomyopathic ● posthemorrhagic ● dehydrationary ● toxico-infectious vasodilatory orthostatic ● hyperthermic ● toxico-infectious ● psychogenic

  4. Shock is the state in which failure of the circulatory system to maintain adequate tissue perfusion results in widespread reduction in delivery of O2 and nutrients to cells

  5. CLASSIFICATION OF SHOCK • HYPOVOLEMIC decrease inCPVdecreasein SVandCOshock circulating plasma volume stroke volume cardiac output 2. CARDIOGENIC decrease in myocardial contractility decreasein CO (cardiac index < 1.8 L/min/m2)shock 3. EXTRACARDIAC OBSTRUCTIVE increased pericardial pressure impairedventricular diastolic filling decrease in SV and COshock considerable increase in the peripheral vascular capacitydiscrepancy between the perfusion 4. DISTRIBUTIVE pressureand the demand of tissues and organs in blood flow, despite N or increasedCOshock

  6. ADAPTIVE REACTIONS AT THE NONPROGRESSIVE STAGE OF SHOCK ►Activation of the sympathetic nervous system by: - baroreceptor reflex - low-pressure vascular stretch receptors - central nervous system ischemic response (when BP < 50 mm Hg) ►Activation of the renin-angiotensin-aldosterone mechanism ►Increased secretion of vasopressin by the posterior pituitary ►Activation of mechanisms that return the blood volume back toward normal: - increased absorption of water from the intestinal tract - conservation of water and salt by the kidneys - thirst and increased appetite for salt

  7. IMPORTANT FACTORS THAT CAUSEIRREVERSIBLE CHANGES IN THE PROGRESSING SHOCK Ischemia of tissues, O2and substrate deficiency Activation of leukocytes Activation of endothelial cells Acidosis Excessive, uncontrolledreleaseofinflammatory mediators andactive oxygen species (О2-, ОН*) Progressively developing andextendinginflammatory process Massive injuryto cellular membranes Intense release oflysosomal enzymes Widespreaddepletion of the cellular energy stores

  8. TYPES OF DISTRIBUTIVE SHOCK ● Neurogenic shock - deep general anesthesia - spinal anesthesia - brain damage in concussion or contusion ● Pain shock ● Anaphylactic shock ● Drug overdose shock ● Adrenal shock (Addisonian crisis) ● Septic shock

  9. Deterioration of the heart function in shock Shock Heart failure Ventricular diastolic pressure Diastolic compliance Heart rate Pressure gradient for coronary perfusion Ischemia

  10. THE MOST COMMON CAUSES OF COMA ■Wide-spread damage in both hemispheres (ischemia, traumaetc.). ■ Suppression of cerebral functionby extrinsic drugs, toxins, hypoxia, internal metabolicderangements (hypoglycemia, azotemia, hepatic failureetc.). ■Brainstem lesions that cause proximate damage to the reticular activating system (RAS).

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