EXTREME CONDITIONS

1. VinnytsyaNational Pirogov Memorial Medical University Pathophysiology Department EXTREME CONDITIONS PhD.,ViktoriyaPiliponova

2. Extreme conditions - severe general condition of the body, developing under the influence of extreme factors of the external or internal environment characterized by significant disturbances of vital activity, fraught with death.

3. Extreme statesare the conditions of an organism characterized by an excessive straining or an exhaustion of adaptive mechanisms. • 1. Primary - action on an organism of various extreme irritators (for example, traumas, endogenic intoxications, severe fluctuations of air temperature and concentration of oxygen) • 2.Secondary - as a result of adverse course of disease (for example, insufficiency of blood circulation, respiratory, renal or hepatic insufficiency, anemia etc.).

4. General etiology of extreme conditions • Extreme factors different from other pathogenic agents that provide the data and the specific conditions under the action of the body is very high, very intense, often devastating effect.

5. Typesofextremefactors: Exogenousfactors: • Factorsofthephysicalnature: mechanical, electrical, thermal, barometric, radiation, gravity. • Chemicalfactors: limitingthedeficit / surplusofoxygen, metabolicsubstrates, liquid; expressedintoxicationofdrugs, industrialpoisons, acids, alkalis. • Biologicalfactors: significantdeficit / surplusofexogenousbioactivesubstances; bacteria, parasitesandfungi (toxins, metabolicproductsthereof, and / ordecay).

6. Endogenous (adverse, severe course of disease and disease states). • Severe impairment of functions of organs and physiological systems. • A significant blood loss. • Massive bleeding in the organs. • Allergic immune responses. • A significant deficiency / excess of BAS and / or their effects. • Mental surge injury.

7. The most important extreme states: • SHOCK • COLLAPSE • COMA

8. Shock - an extremely heavy condition of the body that occurs under the influence of super-strong extreme factors. • Characterized progressive disorder of the body's vital functions as a result of the dysfunction of the nervous, endocrine, cardiovascular and other vital systems.

9. Shock Etiological classification 1. Traumatic; 2. Hemorrhagic; 3. Burn; 4. Anhydremic (dehydrative); 5. Cardiogenic; 6. Pancreatic; 7. Septic; 8. Infection-toxic; 9. Anaphylactic 10. Tourniquet (develops after removal of binder after 4 hours and more after imposing);

10. Shock Pathogenic classification 1. Hypovolemic shock (hemorrhagic, anhydremic). 2. Shock connected with disturbances of pump function of heart (cardiogenic). 3. Vascular forms of shock (anaphylactic, pancreatic). 4. Painful shock at which the central regulation of blood circulation (traumatic, after burning) is damaged.

12. Traumatic shock develops owing to large damages of tissues. • In its clinic two stages are distinguished: • 1. Erectile (excitation); • 2. Torpid (inhibition).

13. Hypovolemic shock - occurs when the loss of more than 20% of BCC because of the acute bleeding or dehydration. Hemorrhagic shock • External bleeding (knife, bullet wound, erosion bleedings of stomach at stomach ulcer, tumors, from lung at tuberculosis etc.) • Internal bleeding (hemothorax, hemoperitonium) bleedings in conditions of tissues traumation. Unhydremic shock • Loss of liquid and electrolytes: 1. During the exudative pleurities, intestinal obturation, peritonitis liquid comes from vascular system into cavities. 2. During the unrestrained vomitting and strong diarrhea the liquid is lost outside. Develops hypovolemia which plays a role of main pathogenetic link.

14. Cardiogenicshock ashockwithasharpdecreaseincardiacoutputandadecreaseinoxygensupplyoftissuesasaresultofviolationsofmyocardial (heartattack, arrhythmias, dilatedcardiomyopathy) ormorphologicaldisorders (acutevalvularinsufficiency, ventricularseptalrupture, thecriticalaorticstenosis, hypertrophiccardiomyopathy).

15. Cardiogenic shock • Pathogenesis. In addition to violations of myocardial contractile function, developed in the cardiogenic shock matters pain factor (myocardial infarction and pulmonary embolism). • Compensatory mechanisms: ADH secretion, release of aldosterone and renin secretion of catecholamines. • Physiological reactions: decreased urine output, leading to fluid overload; vasoconstriction. causing an increase in afterload;

16. Formsofcardiogenicshockaccodingthepathogenesisandclinicalfeatures:Formsofcardiogenicshockaccodingthepathogenesisandclinicalfeatures: • Reflexcardiogenicshock (reflexreactions). • Truecardiogenicshock (impairmentofmyocardialcontractility). • Arrhythmicshock • Unresponsivenessshock (notamenabletodrugtherapy).

17. Transfusion shock • Transfusion shock - a shock that occurs when incompatible blood transfusion as an extreme expression of post-transfusion reactions.

18. Collapse is acute vascular insufficiency, which arises up as a result of decreasing of arterial pressure and diminishing of common blood volume.

19. Classification collapse according etiology: • Posthemorrhagic • Dehydration • Toxic – infectious • Cardiogenic • Orthostatic • Pancreatic • Radiation, others.

20. Classification collapse according pathogenesis Hypovolemic (posthemorrhagic, dehydration) Cardiogenic (acute heart failure) Angiogenic (vazodylyatation)

22. Coma- severe degree of the pathological braking of CNS, which is characterized by the deep loss of consciousness, absence of reflexes on external irritants and violation of vitally important functions of organism.

23. Hans Selye, MD, PhD (1907 - 1982), the “Father of Stress”, was a Hungarian endocrinologist and the first to give a scientific explanation for biological “stress”. • He actually borrowed the term “stress” from physics to describe an organism’s physiological response to perceived stressful events in the environment. • “Every stress leaves an indelible scar, and the organism pays for its survival after a stressful situation by becoming a little older.” - Hans Selye, MD, PhD

24. STRESS - a non-specific response of the body that occurs under the influence of any superstrong stimuli (stressors) or pathogenic factors and is accompanied by are structuring of protective systems. • Stress manifests itself clinically complex structural, physiological and biochemical changes, which are called "general adaptation syndrome".