1. Hemodynamics, Thromboembolism and Shock Review with Animations Nicole L. Draper, MD

2. Aberrant Hemodynamics Heart Failure Left Right Pulmonary edema Pleural effusion Liver Congestion Splenic Congestion GI tract varices Decreased renal blood flow Retention of Na + and H2O Increased blood volume Peripheral edema Ascites Lungs Liver GI Tract Spleen Kidney Skin

3. Embolus Source/CauseOrgan(s) AffectedClinical Outcome Thromboemboli -Venous Deep leg veins, arm veins LungsRespiratory insufficiency, chest pain Fat/Bone Marrow Long bone fractures --> vein damage Lungs Respiratory insufficiency 1-3 days post trauma, mental status changes Amniotic Fluid Torn placental membranes, uterine vein rupture Lungs, brain, vasculature During labor or immediately postpartum onset of respiratory insufficiency, shock, seizures, DIC. 10% of maternal deaths Tumor Mucin-secreting adenocarcinomas, liver, kidney LungsRespiratory insufficiency, chest pain Thromboemboli -Arterial Heart (vegetations or mural thrombi), aorta, carotid artery Legs (75%), brain (10%)Stroke, tissue necrosis in the leg Atheroemboli Atherosclerotic plaque of aorta, iliac, carotid arteries Legs, brain, GI tract, kidney Stroke, tissue necrosis in the leg, GI pain, GI bleeding, acute kidney injury Gas bubbles Diving (Nitrogen), IV, IA or chest trauma (air) Muscle, joints, lungs, heart Bends (skeletal and joint pain), chokes (lung edema and hemorrhage), respiratory insufficiency, myocardial ischemia

4. Disseminated Intravascular Coagulation (DIC) Thrombosis and hemorrhage can occur simultaneously Underlying Condition (Tissue factor release, Endothelial damage) Widespread Fibrin Deposition Systemic Activation of Coagulation Consumption of Platelets and Clotting Factors ThrombosisBleeding

5. Shock Circulating blood volume or blood pressure is not adequate to perfuse body tissues  multiorgan dysfunction/damage Cardiogenic Shock: Myocardial pump failure Myocardial damage, extrinsic compression, outflow obstruction Hypovolemic Shock: Low blood volume Severe dehydration (vomiting, diarrhea), hemorrhage, burns Both Low cardiac output Vasoconstriction Low blood pressureIncreased heart rate Renal conservation of fluid Coolness and pallor of skin, tachycardia, low urine output

6. Shock Systemic Inflammatory Response Syndrome (SIRS) Septic Shock: Microbial infection (bacteria, fungi) Immensely Elevated Inflammatory Mediators Fever, DIC, ARDS Widespread Arterial vasodilation  hypotension, warm, flushed skin Vascular leakage  hypotension, edema Venous blood pooling  reduced cardiac output, increased heart rate Often not responsive to IV fluids

7. The process in this patient’s leg that has left an indentation where a finger pressed is? A. Hemorrhage B. Infarct C. Edema D. Effusion Question http://www.massage-education.com/edema.html

8. The finding in this patient’s brain is most consistent with? A. Effusion B. Neoplasm C. Hemorrhage D. Infarct Question http://neuropathology-web.org/chapter2/chapter2bCerebralinfarcts.html

9. What type of shock would likely be associated with the findings in this esophagus? A. Hypovolemic B. Septic C. Cardiogenic D. Anaphylactic Question Pre-Tx Post-Tx http://varicesnuncamas.qd-shop.net/tag/what-are-varices-in-esophagus

10. What type of shock would be associated with the finding in the lungs seen during this autopsy? A. Hypovolemic B. Septic C. Cardiogenic D. Neurogenic Question http://www.microscopyu.com/staticgallery/pathology/chronicpneumonia20x03.html