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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

where can we find the short bones
Chidi Reply
Carpal bones are examples of short bones
Dara
what is blood supply
Chidi
on upper limb and lower limb
Juma
carpal bones
Priya
during pregnancy which would more increase size the mothers abdominal or pelvic cavity?
Nurmalyn Reply
pelvic cavity I think
Priya
What is anatomical position
Nwoye
define the main directional terms of the body
cris Reply
during physical exercise respiratory rate increace two student are discussing the mechanisms involved. student A claim they are positive feedback and student B claim negative feedback do you agree with student A or B and why
cris
what is the physiology of circulation
Chidi
please I mean the physiology of criculation
Chidi
blood flow refers to the movement of blood through the vessels from arteries to the capillaries and then to the veins
Laraib
during pregnancy, which would more size the mother's abdominal or pelvic cavity? explain
cris Reply
list and define the three plane of devision of the body
cris
complete the following statements using correct directional terms for human being. 1. the navel is________to the nose 2. the heart is______to the breastbone(sternum) 3 the ankle is______to the knee 4 the ear is______to the eyes.
cris
1. superior 2. posterior 3. superior 4. lateral
Mnm
anterior fuerior
Chidi
name the system of the body and its function
cris Reply
11 system are human body 1.integumentary system 2. skeletal system 3. muscular system 4. nervous system 5. endocrine system 6. cardiovascular system 7. lymphatic system 8. respiratory system 9. digestive system 10. urinary system 11. reproductive system male and female.
Vineeta
during pregnancy, which would more size the mother's abdominal or pelvic cavity? explain
cris
how the body maintain hormeostasis in terms of bloodglucose level
cris Reply
It releases hormones from the pancreas insulin and glucagon
TONY
why human blood pressure high
amin Reply
fear, anxiety, sickness
Inemesit
why in mothers womb the foetus head is in anus direction?
Kick
As it seems the position downside n if we did such position thn soon we got vomiting then how foetus stay in downward position long time?
Kick
What is red blood cell
HANNAH Reply
A type of blood cell that is made in the bone marrow and found in the blood. Red blood cells contain a protein called hemoglobin, which carries oxygen from the lungs to all parts of the body. Checking the number of red blood cells in the blood is usually part of a complete blood cell (CBC) test. It
Noor
red blood cell are the most numerous blood cells.they comprise about 99% of all blood cells red blood cells are non nucleated it has red colour due to present to hemoglobin.
Vineeta
Thanks for the answers
HANNAH
how will you promote quality of life in ptb patient using the 14 basic needs and 21 nursing problems?
rOx Reply
coronary circulation ?
Juri Reply
Coronary circulation is the circulation of blood in the blood vessels that supply the heart muscle (myocardium). Coronary arteries supply oxygenated blood to the heart muscle, and cardiac veins drain away the blood once it has been deoxygenated. Because the rest of the body.
Riyaz
coronary circulation ,is flow of blood that supplies the heart tissue itself is the coronary circulation. the functional blood supply of the heart,is the shortest circulation in tha body.
Vineeta
what about the easy way to understand action potential
Bright
event of cardiac cycle
Juri Reply
hii
Chandan
hi 😷be safe your self
John
atrialsystole, ventricular systole,complete cardiac diastole
Priya
intrisic process which done by automic nerve
Juma
whatisanatom
kaso Reply
anatomy is the scientific way of studying the body structure.
cynthia
the branch of science concerned with the bodily structure of humans, animals, and other living organisms, especially as revealed by dissection and the separation of parts.
Noor
what is means by LAPE and HAPE
Noor
what is respiratory rate
Chidi
guys i've question what occur when homeostasis balance mechanisms lost
cris Reply
Bladder is blank to the small intestine, what is the right directional term for that?
Julaika Reply
When peristaltic movement is correct.
Farid
what tissue that support body organ?
Sabrina Reply
the skeleton
veronica
Skeleton
GEBAH
skeleton
Juwita
skeleton
Farid
skeleton
Priya
skeleton
Emmanuel
skeleton
Noor
skeleton
BILAL
skeleton
hanuman

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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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