1. Clinical vignette 1Multiple injuryHwmoMaryam AL-Qahtani.G:3

2. Hemorrhagic shockis a condition of reduced tissue perfusion,resulting in the inadequate delivery of oxygenand nutrients that are necessary for cellularfunction. 3. Objectives:Describe in detail how this patient's bodywould compensate for his primary problem.Is this patient's urinary output normal? 4. How this patient'sbody wouldcompensate for hisprimary problem? 5. The bodys response:Compensated Shock.Decompensated Shock.Irreversible Shock. 6. Compensated Shock.These are the main mechanisms usedto compensate the patients condition:1- The baroreceptor reflex.2- Increased sympathetic nervous systemstimulation.3- Renin-angiotensin-aldosterone (R-A-A) axis. 7. Compensated Shock.Baroreceptor reflex:Blood volumeSystemic arterial bloodpressure 8. Increased sympathetic nervous system stimulation helpsto maintain systemic blood pressure in the followingways:1/ Increasing the contractility of the heart....>increasing stroke volume.2/ Increasing the frequency of action potentials ......>increasing the heart rate. 9. 3/This increases the resistance ....>raising blood pressure.4/contraction of smooth muscle in thesystemic veins.....> increasing the rateof return of venous blood to the heart(increases the pre-load and thus strokevolume of the heart.) 10. Renin-angiotensin-aldosterone(R-A-A)axis. 11. Urinary Output(Normal or abnormal) 12. Case:Urinary output =20ml per hour.Normalvalue:Range of 30- 50 ml per hour. 13. In general :hemorrhagic shockReduce blood flow to the kidneysMaking it difficult for the kidneys to cleanse thebloodstream of waste products and to obtainenough oxygen and nutrients for its ownmetabolic needs. 14. Quiz 15. One of these body response is not one ofcompensate for hemorrhagic :Increase heart rateIncrease blood pressureDecrease stroke volume 16. Normal value of urinary output= 17. Compensated Shock:Early stages of shock where the bodys compensatorymechanisms are able to maintain normal perfusion ..Normal range of urinary output 30-50 ml per hour. 18. Guyton & Hall. Text book of Medical physiology ..Merck Manual..Up to data. Websitehttp://classes.midlandstech.edu/carterp/Courses/bio211/chap19/chap19.htmlhttp://www.ccmtutorials.com/cvs/shock/page_5.5.htm