#ITUmedicine answer - E (D acceptable too). This is neurogenic shock, a cause of warm shock. Shock is defined as inadequate end organ perfusion, and ultimately all patients will die from shock. Understanding the types and manifestations of shock therefore, is key to understanding the concepts that keep people alive when they are sick! A low blood pressure underpins the bulk of the various forms of shock - leading to insufficient pressures to deliver blood and oxygen to vital organs. Organ failure and signs of anaerobic respiration (poor renal function, acidosis, rising lactate etc) also support the identification of shock. In neurogenic shock, the pathogenesis is destruction of the pathways and structures involved in the innervation of the smooth muscle of the vasculature +/- sympathetic stimulation of the heart. This leads to relatively flaccid, atonic and dilated blood vessels that pool blood in them (hence, the limbs are flooded and red). Often, there is an associated bradycardia which compounds the issue. The formula for blood pressure is - BP = Cardiac output * Total peripheral vascular resistance Neurogenic shock therefore manifests largely through the reduction of the total peripheral vascular resistance. The presence of bradycardia will also reduce cardiac output (cardiac output = heart rate * stroke volume). ABC resuscitate the patient and give fluids to maintain an adequate BP. :-)
Posted on: Sun, 09 Nov 2014 11:32:57 +0000
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