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Homeostatic responses to loss of blood volume

This flowchart shows the action of decreased blood pressure and volume in the neural and endocrine mechanisms.

Circulatory shock

The loss of too much blood may lead to circulatory shock    , a life-threatening condition in which the circulatory system is unable to maintain blood flow to adequately supply sufficient oxygen and other nutrients to the tissues to maintain cellular metabolism. It should not be confused with emotional or psychological shock. Typically, the patient in circulatory shock will demonstrate an increased heart rate but decreased blood pressure, but there are cases in which blood pressure will remain normal. Urine output will fall dramatically, and the patient may appear confused or lose consciousness. Urine output less than 1 mL/kg body weight/hour is cause for concern. Unfortunately, shock is an example of a positive-feedback loop that, if uncorrected, may lead to the death of the patient.

There are several recognized forms of shock:

  • Hypovolemic shock in adults is typically caused by hemorrhage, although in children it may be caused by fluid losses related to severe vomiting or diarrhea. Other causes for hypovolemic shock include extensive burns, exposure to some toxins, and excessive urine loss related to diabetes insipidus or ketoacidosis. Typically, patients present with a rapid, almost tachycardic heart rate; a weak pulse often described as “thread;” cool, clammy skin, particularly in the extremities, due to restricted peripheral blood flow; rapid, shallow breathing; hypothermia; thirst; and dry mouth. Treatments generally involve providing intravenous fluids to restore the patient to normal function and various drugs such as dopamine, epinephrine, and norepinephrine to raise blood pressure.
  • Cardiogenic shock results from the inability of the heart to maintain cardiac output. Most often, it results from a myocardial infarction (heart attack), but it may also be caused by arrhythmias, valve disorders, cardiomyopathies, cardiac failure, or simply insufficient flow of blood through the cardiac vessels. Treatment involves repairing the damage to the heart or its vessels to resolve the underlying cause, rather than treating cardiogenic shock directly.
  • Vascular shock occurs when arterioles lose their normal muscular tone and dilate dramatically. It may arise from a variety of causes, and treatments almost always involve fluid replacement and medications, called inotropic or pressor agents, which restore tone to the muscles of the vessels. In addition, eliminating or at least alleviating the underlying cause of the condition is required. This might include antibiotics and antihistamines, or select steroids, which may aid in the repair of nerve damage. A common cause is sepsis    (or septicemia), also called “blood poisoning,” which is a widespread bacterial infection that results in an organismal-level inflammatory response known as septic shock    . Neurogenic shock is a form of vascular shock that occurs with cranial or spinal injuries that damage the cardiovascular centers in the medulla oblongata or the nervous fibers originating from this region. Anaphylactic shock is a severe allergic response that causes the widespread release of histamines, triggering vasodilation throughout the body.
  • Obstructive shock , as the name would suggest, occurs when a significant portion of the vascular system is blocked. It is not always recognized as a distinct condition and may be grouped with cardiogenic shock, including pulmonary embolism and cardiac tamponade. Treatments depend upon the underlying cause and, in addition to administering fluids intravenously, often include the administration of anticoagulants, removal of fluid from the pericardial cavity, or air from the thoracic cavity, and surgery as required. The most common cause is a pulmonary embolism, a clot that lodges in the pulmonary vessels and interrupts blood flow. Other causes include stenosis of the aortic valve; cardiac tamponade, in which excess fluid in the pericardial cavity interferes with the ability of the heart to fully relax and fill with blood (resulting in decreased preload); and a pneumothorax, in which an excessive amount of air is present in the thoracic cavity, outside of the lungs, which interferes with venous return, pulmonary function, and delivery of oxygen to the tissues.

Chapter review

Neural, endocrine, and autoregulatory mechanisms affect blood flow, blood pressure, and eventually perfusion of blood to body tissues. Neural mechanisms include the cardiovascular centers in the medulla oblongata, baroreceptors in the aorta and carotid arteries and right atrium, and associated chemoreceptors that monitor blood levels of oxygen, carbon dioxide, and hydrogen ions. Endocrine controls include epinephrine and norepinephrine, as well as ADH, the renin-angiotensin-aldosterone mechanism, ANH, and EPO. Autoregulation is the local control of vasodilation and constriction by chemical signals and the myogenic response. Exercise greatly improves cardiovascular function and reduces the risk of cardiovascular diseases, including hypertension, a leading cause of heart attacks and strokes. Significant hemorrhage can lead to a form of circulatory shock known as hypovolemic shock. Sepsis, obstruction, and widespread inflammation can also cause circulatory shock.

Listen to this CDC podcast to learn about hypertension, often described as a “silent killer.” What steps can you take to reduce your risk of a heart attack or stroke?

Take medications as prescribed, eat a healthy diet, exercise, and don’t smoke.

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References

Centers for Disease Control and Prevention (US). Getting blood pressure under control: high blood pressure is out of control for too many Americans [Internet]. Atlanta (GA); [cited 2013 Apr 26]. Available from: (External Link)

Questions & Answers

Minimum blood pressure
Hasnain Reply
120/80
AmirHameed
90/60
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120/80
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SA node produces impulse is called pacemaker
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IDDRISU
which of the following is the epithelial tissue that lines the interior of blood vessels?
Firomsa Reply
endothelial tissues
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Endothelial tissue
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the long bone with two primary center's of ossification for shaft is ________
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medulla
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There are only six days during any cycle when a woman can get pregnant - the five days leading up to ovulation and the 24 hours after ovulation. This is because sperm can live for up to 5 days in a woman's body, and the ovum lives for only 12-24 hours.
THE
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It's the men version of menopause!
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If our blood sugar drops below 70 mg/dL, we may have symptoms, such as feeling tired, weak, or shaky, become confused or drowsy or even lose consciousness and possibly die.
Dhanya
symptoms of hypoglycemia include: shakiness, dizziness, headache, confusion, rapid pulse rate, sweating, Hunger, etc.
EMERIBE
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Nikky Reply
what is respiratory
Nikky
Respiratory is breathing
Atone
respiration is an exchange of gases (O2 & CO2) between the body and outside environment.
joey
homeostasis is internal balance.
Ali
Respiratory is system where the body takes in oxygen n releases carbondioxide
Hassan
respiratory system is a system where exhalation and inhalation takes place
Kom
1)inhalation: active diaphragm & external intercoastal muscles 2)exhalation: passive (allow muscle group to relax)
Shoukat
mantaince of body is called homeostasis
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Face ki he ethmoid bone
Rakesh
ethmoid bone. Irregularly shaped bone anterior to the solenoid. Forms the roof of the nasal cavity, upper nasal septum, and part of the medial orbit walls.
LaKecia
Its unpaired bone of skull that saprate the nasal cavity from the brain it's located at the roof of the nose between the two orbits it's bone is one of the bones that make up the orbit of eye.
SARFARAJ
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LaKecia
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Rakesh
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Rakesh
Also included in the ethmoid bone is the crista galli and the cribriform plates. The plates help form the roof of the nasal cavity and the floor of the anterior cranial fossa.
LaKecia
the outer most covering of the brain ( the dura mater) attached to the crista galli and helps secure the brain in the cranial cavity
LaKecia
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LaKecia
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sk
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sk
respiration is the process of inspiration an expiration
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sk
The protection of internal envirnment from the harm of external envirnmen is called as homeostasis.
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skin
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Source:  OpenStax, Anatomy & Physiology. OpenStax CNX. Feb 04, 2016 Download for free at http://legacy.cnx.org/content/col11496/1.8
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