Cardiogenic Shock | Shock (Part 4)

[@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.

[@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!

[@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!

[@shannondurham7510]

Most helpful nursing channel on KZbin!

[@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.

[@iba423]

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

[@vamp3]

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

[@ICUAdvantage]

Thank you so much! Glad you liked it

[@irenes3971]

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

[@ICUAdvantage]

Thank you so much Irene! ❤️

[@dulajashen777]

Thank you so much 🎇

[@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.

[@anghelsalupa1o1]

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

[@ICUAdvantage]

Awesome. happy to hear this Samantha!

[@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.

[@darshanmishra1666]

Amazing Videos Sir

[@indrajeet1316]

Thank you so very much From India

[@ICUAdvantage]

Very cool! You're welcome!

[@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.

[@alexclark1464]

Wouldn't it be contraindicated to give vasopressors for cardiogenic shock since the afterload might increase further worsening cardiac output and the ability of the heart to pump blood?

[@nathandaily7081]

Fire !!! 😊

[@joeyborja8787]

Good video! very informative. Thank you.

[@ICUAdvantage]

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?

[@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.

[@omrawah7003]

I like your explanation and all your series Keep going

[@ICUAdvantage]

I really appreciate that. I will!

[@edmundpolicarpio]

❤❤❤❤❤❤ Thank you!

[@etomidateem222]

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

[@ICUAdvantage]

Wow, yes, good catch! 100% 🤦🏻‍♂️

[@prof.dr.huseyinbozbas498]

thanks for nice presentation

[@ICUAdvantage]

You are most welcome

[@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

[@langlingbisdak6818]

Thank you

[@dgmnhn2098]

Thanks !

[@Chelioos]

Good video, thanks

[@ICUAdvantage]

Glad you liked it!

[@bharatipawar1962]

Thank you!

[@ICUAdvantage]

You're welcome!

[@benclarke6886]

for what does JVD stand for?

[@lobarita]

my usual thank you comment!

[@ICUAdvantage]

Haha I do appreciate that Jacob!

[@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.

[@adanismac71]

Keep going

[@ICUAdvantage]

Will do

[@SavingOurRepublic]

😊 Thanks

[@ICUAdvantage]

You're welcome! :)

[@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.

[@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.

[@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.

[@sleepingvideostorelaxtoo2736]

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

[@venkybly]

Tq

[@ICUAdvantage]

Wow thank you again!

[@kettyNdulwa-md5wi]

Love

[@danao1796]

💙👌

[@ICUAdvantage]

Thank you!

[@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]

👍❤

[@mrslavochin]

Thank you!