Reduced circulating blood volume Sympathetic response Tissue perfusion to multiple organs

Kidneys

Adrenals

Liver

GI

Vasoconstriction

Lungs

Acute tubular necrosis

Production & release of mineralocorticoids & glucocorticoids

Metabolic deficiencies

Impaired ability to detoxify

Intestinal injury

Myocardial depressant factor release from pancreas

Cardiac output

O2/CO2 exchange

O2 carrying capacity

Aldosterone

Na & H2O retention

Proliferation of bacteria / virus and endotoxins in the blood

BP

Weak, thready, rapid pulse

Sympathetic stimulation

Oliguria or anuria

Intravascular volume

Capillary permeability Pulse pressure Blood to the brain Anxiousness, nervousness, irritability HR

Adrenal hemorrhage RR Dizziness, fainting, &/or unconsciousness Apathy, confusion, restlessness O2 to tissues

Respiratory alkalosis

Cellular hypoxia

Cell death

Anaerobic metabolism

Release of cellular enzymes

Lactic acid accumulation

Capillary permeability

Metabolic acidosis

Hypercoagulable blood + precipitating factor

Tissue damage

Endothelial damage

Increased tissue thomboplastin

Intrinsic pathway of coagulation

Extrinsic pathway of coagulation Fresh frozen plasma Intravascular coagulation (production of microthrombi) Platelets

Production of thrombi

Consumption of clotting factors

Activation of fibrinolytic system Cryoprecipitate Factor VIII Digestion of fibrin clots Blood Transfusion

Decreased clotting factors

Thrombocytopenia

Inhibition of platelet function

Extensive Bleeding