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46-642: Anneville-Ambourville is a quarrying and farming village situated in the Roumois , inside a meander of the river Seine , some 11 miles (18 km) northwest of Rouen near the junction of the D45 with the D64 road. This Rouen geographical article is a stub . You can help Misplaced Pages by expanding it . Quarry A quarry is a type of open-pit mine in which dimension stone , rock , construction aggregate , riprap , sand , gravel , or slate

92-755: A systolic blood pressure of 70–90 mmHg, or until the patient has adequate mentation and peripheral pulses. Hypertonic fluid may also be an option in this group. Vasopressors may be used if blood pressure does not improve with fluids. Common vasopressors used in shock include: norepinephrine , phenylephrine , dopamine , and dobutamine . There is no evidence of substantial benefit of one vasopressor over another; however, using dopamine leads to an increased risk of arrhythmia when compared with norepinephrine. Vasopressors have not been found to improve outcomes when used for hemorrhagic shock from trauma but may be of use in neurogenic shock . Activated protein C (Xigris), while once aggressively promoted for

138-420: A 1–4 scale on the physical signs. The shock index (heart rate divided by systolic blood pressure) is a stronger predictor of the impact of blood loss than heart rate and blood pressure alone. This relationship has not been well established in pregnancy-related bleeding. Cardiogenic shock is caused by the failure of the heart to pump effectively. This can be due to damage to the heart muscle, most often from

184-417: A cellular level, shock is the process of oxygen demand becoming greater than oxygen supply. One of the key dangers of shock is that it progresses by a positive feedback loop. Poor blood supply leads to cellular damage, which results in an inflammatory response to increase blood flow to the affected area. Normally, this causes the blood supply level to match with tissue demand for nutrients. However, if there

230-538: A central line correlates well with SmvO2 and is easier to acquire. Tissue oxygenation is critically dependent on blood flow. When the oxygenation of tissues is compromised anaerobic metabolism will begin and lactic acid will be produced. Treatment of shock is based on the likely underlying cause. An open airway and sufficient breathing should be established. Any ongoing bleeding should be stopped, which may require surgery or embolization . Intravenous fluid , such as Ringer's lactate or packed red blood cells ,

276-422: A fast heart rate is common, in those on β-blockers , those who are athletic, and in 30% of cases of those with shock due to intra abdominal bleeding, heart rate may be normal or slow. Specific subtypes of shock may have additional symptoms. Dry mucous membrane , reduced skin turgor , prolonged capillary refill time , weak peripheral pulses, and cold extremities can be early signs of shock. Hypovolemic shock

322-469: A large myocardial infarction . Other causes of cardiogenic shock include dysrhythmias , cardiomyopathy / myocarditis , congestive heart failure (CHF), myocardial contusion , or valvular heart disease problems. Symptoms of cardiogenic shock include: Obstructive shock is a form of shock associated with physical obstruction of the great vessels of the systemic or pulmonary circulation. Several conditions can result in this form of shock. Many of

368-469: A rate of about 2% of the cell's total need per hour, even restoring oxygen is futile at this point because there is no adenosine to phosphorylate into ATP. The diagnosis of shock is commonly based on a combination of symptoms, physical examination , and laboratory tests. Many signs and symptoms are not sensitive or specific for shock, thus many clinical decision-making tools have been developed to identify shock at an early stage. A high degree of suspicion

414-449: A reaction to the sudden impact of a missile. However, the first English writer to use the word shock in its modern-day connotation was James Latta, in 1795. Prior to World War I , there were several competing hypotheses behind the pathophysiology of shock. Of the various theories, the most well regarded was a theory penned by George W. Crile who suggested in his 1899 monograph, " An Experimental Research into Surgical Shock" , that shock

460-493: A stable, self-correcting trajectory. Otherwise the condition can become increasingly difficult to correct, surprisingly quickly, and then progress to a fatal outcome. In the particular case of anaphylactic shock, progression to death might take just a few minutes. During the Initial stage (Stage 1), the state of hypoperfusion causes hypoxia . Due to the lack of oxygen, the cells perform lactic acid fermentation . Since oxygen,

506-403: A subcategory of shock, many endocrinological disturbances in their severe form can result in shock. Shock is a common end point of many medical conditions. Shock triggered by a serious allergic reaction is known as anaphylactic shock , shock triggered by severe dehydration or blood loss is known as hypovolemic shock , shock caused by sepsis is known as septic shock , etc. Shock itself

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552-407: Is a life-threatening condition as a result of compromised body circulation . It can be divided into four main types based on the underlying cause: hypovolemic, distributive, cardiogenic, and obstructive. A few additional classifications are occasionally used, such as endocrinologic shock. Shock is a complex and continuous condition, and there is no sudden transition from one stage to the next. At

598-407: Is delayed or the antimicrobial drugs are ineffective, however has a mortality rate between 30% and 80%; cardiogenic shock has a mortality rate of up to 70% to 90%, though quick treatment with vasopressors and inotropic drugs, cardiac surgery, and the use of assistive devices can lower the mortality. There is no evidence of the word shock being used in its modern-day form prior to 1743. However, there

644-447: Is enough increased demand in some areas, it can deprive other areas of sufficient supply, which then start demanding more. This then leads to an ever escalating cascade. As such, shock is a runaway condition of homeostatic failure, where the usual corrective mechanisms relating to oxygenation of the body no longer function in a stable way. When it occurs, immediate treatment is critical in order to return an individual's metabolism into

690-461: Is evidence that Hippocrates used the word exemia to signify a state of being "drained of blood". Shock or "choc" was first described in a trauma victim in the English translation of Henri-François LeDran 's 1740 text, Traité ou Reflexions Tire'es de la Pratique sur les Playes d'armes à feu (A treatise, or reflections, drawn from practice on gun-shot wounds .) In this text he describes "choc" as

736-590: Is excavated from the ground. The operation of quarries is regulated in some jurisdictions to manage their safety risks and reduce their environmental impact. The word quarry can also include the underground quarrying for stone, such as Bath stone . Types of rock extracted from quarries include: Stone quarry is an outdated term for mining construction rocks (limestone, marble, granite, sandstone, etc.). There are open types (called quarries, or open-pit mines) and closed types ( mines and caves). For thousands of years, only hand tools had been used in quarries. In

782-650: Is generally not recommended. Unexpectedly cold water can cause a swimmer's muscles to suddenly weaken; it can also cause shock and even hypothermia . Though quarry water is often very clear, submerged quarry stones, abandoned equipment, dead animals and strong currents make diving into these quarries extremely dangerous. Several people drown in quarries each year. However, many inactive quarries are converted into safe swimming sites. Such lakes, even lakes within active quarries, can provide important habitat for animals. S.K Duggal "Building Materials" (2003) 3rd revised edition Quarries Shock (circulatory) Shock

828-433: Is necessary for the proper diagnosis of shock. Shock is, hemodynamically speaking, inadequate blood flow or cardiac output , Unfortunately, the measurement of cardiac output requires an invasive catheter, such as a pulmonary artery catheter. Mixed venous oxygen saturation (SmvO2) is one of the methods of calculating cardiac output with a pulmonary artery catheter. Central venous oxygen saturation (ScvO2) as measured via

874-477: Is often given. Efforts to maintain a normal body temperature are also important. Vasopressors may be useful in certain cases. Shock is both common and has a high risk of death. In the United States about 1.2 million people present to the emergency room each year with shock and their risk of death is between 20 and 50%. The best evidence exists for the treatment of septic shock in adults. However,

920-405: Is pollution of roads from trucks leaving the quarries. To control and restrain the pollution of public roads, wheel washing systems are becoming more common. Many quarries naturally fill with water after abandonment and become lakes . Others are made into landfills . Water-filled quarries can be very deep, often 50 ft (15 m) or more, and surprisingly cold, so swimming in quarry lakes

966-414: Is released to conserve fluid by reducing its excretion via the renal system. These hormones cause the vasoconstriction of the kidneys , gastrointestinal tract , and other organs to divert blood to the heart, lungs and brain . The lack of blood to the renal system causes the characteristic low urine production. However, the effects of the renin–angiotensin axis take time and are of little importance to

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1012-482: Is reversible if it's recognized and treated early in time. Aggressive intravenous fluids are recommended in most types of shock (e.g. 1–2 liter normal saline bolus over 10 minutes or 20 mL/kg in a child) which is usually instituted as the person is being further evaluated. Colloids and crystalloids appear to be equally effective with respect to outcomes., Balanced crystalloids and normal saline also appear to be equally effective in critically ill patients. If

1058-412: Is severe. In select cases, compression devices like non-pneumatic anti-shock garments (or the deprecated military anti-shock trousers ) can be used to prevent further blood loss and concentrate fluid in the body's head and core. It is important to keep the person warm to avoid hypothermia as well as adequately manage pain and anxiety as these can increase oxygen consumption. Negative impact by shock

1104-459: Is the most common type of shock and is caused by insufficient circulating volume . The most common cause of hypovolemic shock is hemorrhage (internal or external); however, vomiting and diarrhea are more common causes in children. Other causes include burns, as well as excess urine loss due to diabetic ketoacidosis and diabetes insipidus . Signs and symptoms of hypovolemic shock include: The severity of hemorrhagic shock can be graded on

1150-404: Is the state of insufficient blood flow to the tissues of the body as a result of problems with the circulatory system . Initial symptoms of shock may include weakness, fast heart rate , fast breathing , sweating , anxiety, and increased thirst. This may be followed by confusion, unconsciousness , or cardiac arrest , as complications worsen. Shock is divided into four main types based on

1196-523: Is to achieve a urine output of greater than 0.5 mL/kg/h, a central venous pressure of 8–12 mmHg and a mean arterial pressure of 65–95 mmHg. In trauma the goal is to stop the bleeding which in many cases requires surgical interventions. A good urine output indicates that the kidneys are getting enough blood flow. Septic shock (a form of distributive shock) is the most common form of shock. Shock from blood loss occurs in about 1–2% of trauma cases. Overall, up to one-third of people admitted to

1242-448: The intensive care unit (ICU) are in circulatory shock. Of these, cardiogenic shock accounts for approximately 20%, hypovolemic about 20%, and septic shock about 60% of cases. The prognosis of shock depends on the underlying cause and the nature and extent of concurrent problems. Low volume, anaphylactic, and neurogenic shock are readily treatable and respond well to medical therapy. Septic shock , especially septic shock where treatment

1288-445: The arteriolar smooth muscle and precapillary sphincters relax such that blood remains in the capillaries . Due to this, the hydrostatic pressure will increase and, combined with histamine release, will lead to leakage of fluid and protein into the surrounding tissues. As this fluid is lost, the blood concentration and viscosity increase, causing sludging of the micro-circulation. The prolonged vasoconstriction will also cause

1334-426: The condition. As a result of the acidosis , the person will begin to hyperventilate in order to rid the body of carbon dioxide (CO 2 ) since it indirectly acts to acidify the blood; the body attempts to return to acid–base homeostasis by removing that acidifying agent. The baroreceptors in the arteries detect the hypotension resulting from large amounts of blood being redirected to distant tissues, and cause

1380-521: The eighteenth century, the use of drilling and blasting operations was mastered. The term remains used to describe a method of cutting into a certain shape, such as for glass and tile, as a "quarry cut". The method of removal of stones from their natural bed by using different operations is called quarrying. Methods of quarrying include: Following steps are used in the blasting process; Many quarry stones such as marble , granite , limestone , and sandstone are cut into larger slabs and removed from

1426-491: The immediate homeostatic mediation of shock. The Progressive stage (stage 3) results if the underlying cause of the shock is not successfully treated. During this stage, compensatory mechanisms begin to fail. Due to the decreased perfusion of the cells in the body, sodium ions build up within the intracellular space while potassium ions leak out. Due to lack of oxygen, cellular respiration diminishes and anaerobic metabolism predominates. As anaerobic metabolism continues,

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1472-666: The management of septic shock , has been found not to improve survival and is associated with a number of complications. Activated protein C was withdrawn from the market in 2011, and clinical trials were discontinued. The use of sodium bicarbonate is controversial as it has not been shown to improve outcomes. If used at all it should only be considered if the blood pH is less than 7.0. People with anaphylactic shock are commonly treated with epinephrine . Antihistamines , such as Benadryl ( diphenhydramine ) or ranitidine are also commonly administered. Albuterol , normal saline, and steroids are also commonly given. The goal of treatment

1518-442: The pathophysiology of shock in children appears to be similar so treatment methodologies have been extrapolated to children. Management may include securing the airway via intubation if necessary to decrease the work of breathing and for guarding against respiratory arrest. Oxygen supplementation , intravenous fluids , passive leg raising (not Trendelenburg position ) should be started and blood transfusions added if blood loss

1564-485: The person down (unless a head or back injury is suspected), elevate their legs if possible, and keep them warm. If the person is unresponsive, monitor their breathing and be ready to perform CPR if necessary. The presentation of shock is variable, with some people having only minimal symptoms such as confusion and weakness. While the general signs for all types of shock are low blood pressure , decreased urine output , and confusion, these may not always be present. While

1610-433: The person remains in shock after initial resuscitation, packed red blood cells should be administered to keep the hemoglobin greater than 100 g/L. For those with hemorrhagic shock, the current evidence supports limiting the use of fluids for penetrating thorax and abdominal injuries allowing mild hypotension to persist (known as permissive hypotension ). Targets include a mean arterial pressure of 60 mmHg,

1656-447: The primary reasons that shock is irreversible at this point is that much of the cellular ATP (the basic energy source for cells) has been degraded into adenosine in the absence of oxygen as an electron receptor in the mitochondrial matrix . Adenosine easily perfuses out of cellular membranes into extracellular fluid, furthering capillary vasodilation , and then is transformed into uric acid . Because cells can only produce adenosine at

1702-512: The quarry. The surfaces are polished and finished with varying degrees of sheen or luster . Polished slabs are often cut into tiles or countertops and installed in many kinds of residential and commercial properties. Natural stone quarried from the earth is often considered a luxury and tends to be a highly durable surface, thus highly desirable. Quarries in level areas with shallow groundwater or which are located close to surface water often have engineering problems with drainage . Generally

1748-416: The release of epinephrine and norepinephrine . Norepinephrine causes predominately vasoconstriction with a mild increase in heart rate , whereas epinephrine predominately causes an increase in heart rate with a small effect on the vascular tone; the combined effect results in an increase in blood pressure . The renin–angiotensin axis is activated, and arginine vasopressin (anti-diuretic hormone)

1794-422: The signs of obstructive shock are similar to cardiogenic shock, although treatments differ. Symptoms of obstructive shock include: Distributive shock is low blood pressure due to a dilation of blood vessels within the body. This can be caused by systemic infection ( septic shock ), a severe allergic reaction ( anaphylaxis ), or spinal cord injury ( neurogenic shock ). Although not officially classified as

1840-551: The terminal electron acceptor in the electron transport chain , is not abundant, this slows down entry of pyruvate into the Krebs cycle , resulting in its accumulation. The accumulating pyruvate is converted to lactate (lactic acid) by lactate dehydrogenase . The accumulating lactate causes lactic acidosis . The Compensatory stage (Stage 2) is characterised by the body employing physiological mechanisms, including neural, hormonal, and bio-chemical mechanisms, in an attempt to reverse

1886-419: The underlying cause: hypovolemic , cardiogenic , obstructive , and distributive shock . Hypovolemic shock, also known as low volume shock, may be from bleeding, diarrhea , or vomiting. Cardiogenic shock may be due to a heart attack or cardiac contusion . Obstructive shock may be due to cardiac tamponade or a tension pneumothorax . Distributive shock may be due to sepsis , anaphylaxis , injury to

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1932-469: The upper spinal cord , or certain overdoses . The diagnosis is generally based on a combination of symptoms, physical examination , and laboratory tests. A decreased pulse pressure ( systolic blood pressure minus diastolic blood pressure ) or a fast heart rate raises concerns. Shock is a medical emergency and requires urgent medical care. If shock is suspected, call for emergency help immediately. While waiting for medical care, if safe to do so, lay

1978-400: The vital organs to be compromised due to reduced perfusion . If the bowel becomes sufficiently ischemic , bacteria may enter the blood stream, resulting in the increased complication of endotoxic shock . At Refractory stage (stage 4), the vital organs have failed and the shock can no longer be reversed. Brain damage and cell death are occurring, and death will occur imminently. One of

2024-535: The water higher during removal; this can become the limiting factor in quarry depth. Some water-filled quarries are worked from beneath the water, by dredging. Many people and municipalities consider quarries to be eyesores and require various abatement methods to address problems with noise, dust, and appearance. One of the more effective and famous examples of successful quarry restoration is Butchart Gardens in Victoria, British Columbia, Canada. A further problem

2070-538: The water is removed by pumping while the quarry is operational, but for high inflows more complex approaches may be required. For example, the Coquina quarry is excavated to more than 60 feet (18 m) below sea level. To reduce surface leakage, a moat lined with clay was constructed around the entire quarry. Groundwater entering the pit is pumped up into the moat. As a quarry becomes deeper, water inflows generally increase and it also becomes more expensive to lift

2116-533: Was quintessentially defined as a state of circulatory collapse ( vasodilation ) due to excessive nervous stimulation. Other competing theories around the turn of the century included one penned by Malcom in 1907, in which the assertion was that prolonged vasoconstriction led to the pathophysiological signs and symptoms of shock. In the following World War I, research concerning shock resulted in experiments by Walter B. Cannon of Harvard and William M. Bayliss of London in 1919 that showed that an increase in permeability of

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