Shock reduction in circulatory volume does not recover

2021-04-30 08:09 PM

In severe shock, it eventually reaches the stage where the patient will die, although intensive therapy can still bring cardiac output back to normal in a short time.

After the shock has progressed to a certain stage, a blood transfusion or any other type of therapy will not be able to save a patient's life. This patient was then presumed to be in an irreversible shock. Ironically, even during this irreversible stage, on rare occasions, therapy can bring arterial pressure and even cardiac output back to normal or near-normal within a short time, but the circulatory system continues to deteriorate, and death will happen after a few minutes, a few hours.

The figure demonstrates this effect, suggesting that a blood transfusion in the irreversible stage can sometimes bring the cardiac output (as well as the arterial pressure) back to almost normal. However, early cardiac output began to decline again, and subsequent transfusions were less and less effective. At this point, many of the impaired changes that have occurred in the heart's muscle cells may not necessarily affect the heart's ability to immediately pump blood but over a long period, the heart stops pumping enough leading to death. death. Beyond a certain point in time, too much tissue damage has occurred, a lot of destructive enzymes have been released into the body fluids, a lot of acidoses has developed, and a lot of other destructive factors are underway. output to the point that even normal cardiac output within minutes, could not reverse the further deterioration. Therefore,

Figure. Failure of blood transfusion prevents death in irreversible shock.

The cell's depletion of its high-energy phosphate reserves during irreversible shock. High-energy phosphate stores in body tissues, especially the liver and heart, are significantly reduced during severe shock.

Basically, all creatine phosphate has been broken down, and almost all adenosine triphosphate is degraded to adenosine diphosphate, adenosine monophosphate, and finally adenosine. Most of this adenosine then diffuses out of the cell into the circulatory bloodstream and is converted to uric acid, a substance that cannot penetrate the cell to rebuild the adenosine phosphate system. The new adenosine can be synthesized at a rate of only about 2% of the normal cell count per hour, meaning that once the cells' high energy phosphate reserves are depleted, they are difficult to replenish.

Thus, one of the most devastating outcomes resulting from shock, and perhaps most important to the development of the eventual state, is irreversible, is cellular depletion of energy compounds. This high.



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