Chapter·PathologyGeneral Pathology

Shock pathophysiologyDownloads

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1

A 51-year-old woman is brought into the emergency department following a motor vehicle accident. She is unconscious and was intubated in the field. Past medical history is unknown. Upon arrival, she is hypotensive and tachycardic. Her temperature is 37.2°C (99.1°F), the pulse is 110/min, the respiratory rate is 22/min, and the blood pressure is 85/60 mm Hg. There is no evidence of head trauma, she withdraws to pain and her pupils are 2mm and reactive to light. Her heart has a regular rhythm without any murmurs or rubs and her lungs are clear to auscultation. Her abdomen is firm and distended with decreased bowel sounds. Her extremities are cool and clammy with weak, thready pulses. There is no peripheral edema. Of the following, what is the likely cause of her presentation?

ASeptic shock

BNeurogenic shock

CObstructive shock

DHypovolemic shock

ECardiogenic shock

2

A 56-year-old man is brought to the Emergency Department with intense chest pain that radiates to his left arm and jaw. He also complains of feeling lightheaded. Upon arrival, his blood pressure is 104/60 mm Hg, pulse is 102/min, respiratory rate is 25/min, body temperature is 36.5°C (97.7°F), and oxygen saturation is 94% on room air. An electrocardiogram shows an ST-segment elevation in I, aVL, and V5-6. The patient is transferred to the cardiac interventional suite for a percutaneous coronary intervention. The patient is admitted to the hospital after successful revascularization. During his first night on the ICU floor his urinary output is 0.15 mL/kg/h. Urinalysis shows muddy brown casts. Which of the following outcomes specific to the patient’s condition would you expect to find?

ABlood urea nitrogen (BUN):Serum creatinine ratio (Cr) < 15:1

BUrinary osmolality 900 mOsmol/kg (normal: 500–800 mOsmol/kg)

CUrinary osmolality 550 mOsmol/kg (normal: 500–800 mOsmol/kg)

DFENa+ < 1%

EBlood urea nitrogen (BUN):Serum creatinine ratio (Cr) > 20:1

3

A 40-year-old Caucasian male presents to the emergency room after being shot in the arm in a hunting accident. His shirt is soaked through with blood. He has a blood pressure of 65/40, a heart rate of 122, and his skin is pale, cool to the touch, and moist. This patient is most likely experiencing all of the following EXCEPT:

ADecreased sarcomere length in the myocardium

BIncreased stroke volume

CConfusion and irritability

DDecreased preload

EIncreased thromboxane A2

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