Chapter 1: Physiology, Pathophysiology, and Shock

Protons

located in nucleus, carry positive charge

Neutrons

located in nucleus, carry neutral charge

Electrons

in constant motion around nucleus, carry negative charge

Ions

formed when atom loses electron or gains extra one from another source

Anion

electrons outnumber protons, atom has overall negative charge

Cation

protons outnumber electrons, atom has overall positive charge

Molecule

any structure consisting of 2+ atoms bonded together

Covalent bond

each atom provides electron to form bond

Ionic bond

2 oppositely charged atoms interact, 1 electron is donated from cation to the anion

Ph scale range

0-14

Neutral on pH scale

7

Respiratory acidosis causes

hypoventilation, CA/RA, asphyxiation, head injury

Respiratory acidosis symptoms

slow/no breathing, flushed skin, headache

Respiratory acidosis ETCo2

high

Respiratory alkalosis causes

fever, excessive BVM, anxiety

Respiratory alkalosis symptoms

carpal-pedal spasms, tingling lips and face, dizziness

Respiratory alkalosis ETCo2

low

Metabolic acidosis causes

DKA, lactic acidosis, ASA OD

Metabolic acidosis symptoms

kussmauls, flushed skin, shortness of breath

Metabolic acidosis ETCo2

low

Metabolic alkalosis causes

excessive vomiting, antacid OD, eating disorders

Metabolic alkalosis symptoms

slow breathing, AMS, vomiting

Metabolic alkalosis ETCo2

high

Eukaryotic cells

uni/multicellular organisms, membrane bound with organelles

Cell membrane encloses

cytosol and organelles

Nucleus

control center of the cell containing genetic material

Mitochondria

power house of the cell, produces ATP

Mitochondria can release enzymes from ETC to cause

apoptosis

Apoptosis

programmed cell death

Lysosomes

contain hydrolytic enzymes in the membrane, capable of breaking down cellular waste products

What happens when lysosomal hydrolytic enzymes are released

autolysis

Autolysis

degradation of cellular components

Endoplasmic reticulum

comprised of interconnected membranes that are contiguous with nuclear envelope

Rough ER

contains ribosomes, permit translation of proteins

Smooth ER

lack ribosomes, primarily for lipid synthesis and detox of drugs and poisons

What organ has abundance of SER

liver/hepatocytes

Alcoholics have an increased amount of

SER

Why do alcoholics develop fatty livers

because SER is is involved in lipid synthesis

Peroxisomes

breakdown very long chain fatty acids via beta-oxidation

Cytoskeleton

provides structure to cell

Peripheral vascular resistance

resistance of blood flow through all vessels of body

Cardiac output

amount of blood pumped out of the heart in 1 min

HR x SV =

cardiac output

Stroke volume

amount of blood ejected from LV with each contraction

Heart Rate

number of beats in 1 min

CO x PVR =

BP

Preload

filling and stretching of heart chambers

Afterload

pressure against which the heart pumps

Cardiogenic shock

pump problem and starts in heart, heart is no longer strong enough to move blood around body

Cardiogenic shock often results from

heart attack, cumulative damage from a series of heart attacks

Obstructive shock

pump problem that hampers preload or elevates afterload

Obstructive shock often results from

PE, pneumothorax, reduced venous return

Hypovolemic shock

fluid problem, results from low circulating volume

Distributive shock

size permeability of container results in improper fluid displacement

Different types of distributive shock

anaphylactic, septic, neurogenic, psychogenic

Psychogenic shock

“see blood and faint” type of shock, person becomes scared or overwhelmed which leads to vessel dilation

Compensated shock

body is maintaining BP with compensation

To maintain brain, kidney, and coronary artery perfusion MAP must be

60

MAP equation

2 (DBP) + SBP/3

Decompensated shock

body can no longer maintain BP with compensation

Irreversible shock

extended period of hypotension with no compensation

Kidney failure and death begin in

irreversible shock

General shock treatment

18 GA IV, NSS or LR warmed to approx 100 F given at 20 mL/kg, keep patient warm, keep supine or elevate head no more then 30 degrees

Perfusion goals to gauge successful fluid resus in shock

return of radial pulses, SBP >90, MAP >60