Cardiogenic Shock | Shock (Part 4)

For the 4th lesson in our series on shock we take a good look at cardiogenic shock. In this lesson we will have cardiogenic shock explained full so you have a better understanding of what is going on when your patient is in this type of shock.
We start covering the four different types of cardiogenic shock as well as explaining the cardiogenic shock pathophysiology that is going on with each of these causes as well as in general between them all.
Next we go on to cover the signs that you would be looking for when assessing your patient. Along with this we cover the various diagnostic tests, labs, and hemodynamic values that you would be looking for.
Finally we cover the different avenues of approaches when it comes to treating your patients. We briefly mention the IABP (intra-aortic balloon pump), Impella, and VA ECMO as temporary mechanical support devices as well as some of the other interventions that you would use to support your patient.
We hope that this video helps to have cardiogenic shock made easy for everyone to be able to apply this information in to their daily practice and helpful in the positive outcomes for our patients.
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You can check out the first lesson in this series by clicking here: • What Is Shock? | Shock...
For the next lesson in this series covering obstructive shock, click here: *AWAITING RECORDING*
You can also check out the playlist for this series of lesson on shock here: • What Is Shock? | Shock...
Don't forget to check out our 6-part series of lessons covering Hemodynamics here: • Cardiovascular System ...

[@shannondurham7510]

Most helpful nursing channel on KZbin!

[@laurieturner5169]

Again, thank you so much for making sense of shock in such a clear and concise manner. I just joined as a member, and I must thank you again for your generosity--these videos are worth SO MUCH more than $4.99 per month!

[@ICUAdvantage]

Thank you so much for your support Laurie! Its great to hear the good feedback. I really try my best to consolidate the information in a digestible way!

[@mrslavochin]

Thank you!

[@dontgetsalt2045]

youre a G bro thank you these videos are so much better then the people trying to quickly just list crap out to memorize

[@ICUAdvantage]

Thank you. I certainly try to explain things and break things down in a way to try and give true understanding and not just memorization. Glad it came across well.

[@katiegorman2861]

Hey CCRN of over a decade here. I just wanted to tell you how helpful I find your video's. I mostly watch in my spare time but they are a really great refesher if you have a pt in a shock state that you havent seen in a long time. I also make my student nurse watch you video's about Inotropes. You do a much better job of explaining how they work. It's a really good feeling to have such a great reference to go to. Thanks for what you do!

[@ICUAdvantage]

Hey Katie! Thanks so much for taking the time out to leave such an awesome comment. I really appreciate all that. Happy to hear you've enjoyed the videos and thank you so much for helping to spread the word and helping to educate the next generation of ICU nurses!

[@lukemolet6890]

Currently preparing for my High Acuity exam over hemodynamics and cardiogenic shock and you have explained this much better than my nursing instructors. Thank you for your channel!

[@ICUAdvantage]

Happy to help Luke! Glad to hear the video was helpful for you and best of luck on your exam.

[@irenes3971]

Awesome lecture! Love all ur videos! Thank you very much!

[@ICUAdvantage]

Thank you so much Irene! ❤️

[@langlingbisdak6818]

Thank you

[@vamp3]

You’re amazing man!!! That’s very helpful!!

[@ICUAdvantage]

Thank you so much! Glad you liked it

[@dgmnhn2098]

Thanks !

[@anghelsalupa1o1]

thank you so much!! it helped me a lot to understand Cardiogenic shock.

[@ICUAdvantage]

Awesome. happy to hear this Samantha!

[@edmundpolicarpio]

❤❤❤❤❤❤ Thank you!

[@joeyborja8787]

Good video! very informative. Thank you.

[@ICUAdvantage]

You're welcome!

[@iba423]

I'm so lucky I found your channel... 😇

[@omrawah7003]

It's really helpful and simple and easy to get the information Really really thanks a lot

[@ICUAdvantage]

So great to hear. Thanks for taking the time to leave a comment.

[@darshanmishra1666]

Amazing Videos Sir

[@Chelioos]

Good video, thanks

[@ICUAdvantage]

Glad you liked it!

[@omrawah7003]

I like your explanation and all your series Keep going

[@ICUAdvantage]

I really appreciate that. I will!

[@prof.dr.huseyinbozbas498]

thanks for nice presentation

[@ICUAdvantage]

You are most welcome

[@MattyH-yx2fd]

Thank you so much for making this series! I’m currently studying for a med surge test tomorrow, and this has helped me so much! Thank you again!

[@ICUAdvantage]

Glad to hear this! Hope you did well on your test

[@mutiu.obalogun2866]

@@ICUAdvantage ,, to I.

[@FearIsaLiar]

😊 Thanks

[@ICUAdvantage]

You're welcome! :)

[@indrajeet1316]

Thank you so very much From India

[@ICUAdvantage]

Very cool! You're welcome!

[@chikannanna8014]

Thank u so much for the vuseos, want to clatify Where would you group LAD OR LCX obstruction, would that be part of cardiogenic shock?

[@venkybly]

Tq

[@ICUAdvantage]

Wow thank you again!

[@adanismac71]

Keep going

[@ICUAdvantage]

Will do

[@kettyNdulwa-md5wi]

Love

[@Lina-fq7dt]

Very informative series of lessons it has helped me a lot! Thank you! I have a question, what does CVP refer to?

[@ICUAdvantage]

Glad to hear this. CVP = central venous pressure

[@murse_life]

Why do we want to increase SVR in cardiogenic shock? Is it just to increase perfusion to vital organs? Won’t it increase after load also?

[@Zoro-mj6os]

@@murse_life yes ur right see when svr increases heart needs to function hard initially problem was heart unable to pump so when we increase vascular resistance it will improve perfusion

[@lizelliott1914]

Hi, I love your videos, the only thing is that for the treatment, since SVR in high in cardiogenic shock , wouldn’t be part of the treatment to decrease the SVR with medications like dobutamine that increase the contractility and also will decrease the SVR so when the heart pumps in less resistance and better perfusion?

[@ICUAdvantage]

Great question. And the answer is ultimately yes. The SVR is working against us and making things worse. The only problem is, the SVR is also keeping MAP up, so its a balancing act. If we drop SVR without improving CO then we risk perfusion. Of all the shocks, I've always found cardiogenic to be the toughest one to manage as our fixes often worked against us. Oftentimes, especially in the sick ones, the aid of a circulator device such as Impella can really help bridge the gap.

[@justinchop5531]

Why are we giving Vasopressors such as Levophed when SVR is already high during Cardiogenic Shock? Or is SVR initially high as a compensatory mechanism and decreases later on?

[@ICUAdvantage]

Great question and you are absolutely right in thinking that our pressors are working against us. The problem is, that we still need to support perfusion, and when profoundly hypotensive, the only way we have to do that in the moment, is through using pressors. The problem, as you rightly notice, is that this isn't going to improve our problem and will actually only make it worse, thus we need to work to fix the underlying problem. Sometimes we cannot easily fix this, and thus we may need to move to a device such as IABP, Impella, or even ECMO to assist/provide the forward flow we need until the heart can recover.

[@lobarita]

my usual thank you comment!

[@ICUAdvantage]

Haha I do appreciate that Jacob!

[@danao1796]

💙👌

[@ICUAdvantage]

Thank you!

[@etomidateem222]

4:16 it should be pulmonary veins, not pulmonary artery right

[@ICUAdvantage]

Wow, yes, good catch! 100% 🤦🏻‍♂️

[@Nate_t_AZ]

What will happen to CVP, PAWP, and CO/CI?

[@ICUAdvantage]

CO/CI will be low, CI < 2, infact you index will be low 1's or even less than 1. As a result of low flow forward you'll see increases in CVP and PAP as the blood will back up not being able to move forward.

[@dr.stevenpennym.d.3241]

Have you found that the EF is high or low?

[@ICUAdvantage]

Def low. Heart is not pumping effectively.

[@dr.stevenpennym.d.3241]

@@ICUAdvantage thank you for your reply. I’ve always seen it between 15 and 20%. I spoke to a seasoned cardiologists and he said it’s always high. That doesn’t make sense to me. I’m a double board trauma/cardiothoracic surgeon with 28 years experience. Great video series. Thank you very much.

[@The_outlawHardguard]

Can the patient have more than one cause for his cardiogenic shock?

[@ICUAdvantage]

Certainly possible.

[@Zerob2b]

are diuretics not useful for the treatment? cuz if we've got pulmonary edema i think it might be useful

[@omrawah7003]

I would ask same question

[@ICUAdvantage]

It could be if overloaded, but with cardiogenic shock its more about pump failure. The pulmonary edema is because the blood is backing up because the left side is not moving it forward effectively.

[@sleepingvideostorelaxtoo2736]

im 15 and i have had symptoms for 2 days now i cant get up from bed cause my heart shocks me

[@caterscarrots3407]

Shock causing MI and MI causing shock, sounds like a vicious cycle that would lead to acute heart failure.

[@ICUAdvantage]

Absolutely. I actually talk about this spiral in one of the Heart Failure lessons that I did. Once its begun, there really is no stopping it.

[@tottles1979]

I’m trying to understand how my wife died . They say her heart chamber on right side wasn’t pumping enough blood to organs and they were not getting enough fluid . Why did this present in her tummy and we just thought it was upset tummy 24 hours later she passed because of cardio genic shock. She had aggressive chemotherapy 4 years ago they said that’s what cause the heart problem . My question was if they knew chemo caused this in patients should she have been given heart tracings over the years since

[@chikamsoiwuala3770]

Am sorry for your loss

[@laurieturner5169]

I'm terribly sorry for your loss!

[@GintamaEnjoyer_1]

Как поживаете? кто же не любит похвалу? а в случае этого ролика - хвалить можно совершенно обоснованно. Если кто то из читающих коментарии прод этим видео ищет крутой контент, то вам стоит заценить мой канал!

[@rogervanbommel1086]

???

[@jacobbell6914]

👍❤

[@bharatipawar1962]

Thank you!

[@ICUAdvantage]

You're welcome!