Neurogenic Shock | Shock (Part 7)

[@patriciaspaugy9288]

This video was well put together-it was to the point in reminding me the DIFFERENCES between this type of shock vs all others including spinal shock. THANK YOU

[@Livingthewayiwant]

I’m in love with your voice ❤and thank you for the great teachings

[@EstherMulenga-r2c]

Really appreciate the way you break down these complex concepts so well! Thank you for all you do! Please keep it up!

[@georgepavlik9055]

I wish I found these videos earlier! I have an exam on shock tomorrow and these videos explain it so much better than the PowerPoints or book I have.

[@ICUAdvantage]

Hope the exam went well!

[@georgepavlik9055]

@@ICUAdvantage 92%, didn't miss a shock question!

[@ICUAdvantage]

@@georgepavlik9055 Heck yeah!!!

[@lobarita]

Hey Eddie, Just interviewed for CRNA school. I am overall happy with my performance, however, I missed multiple nuero questions because I didn't study it too much. Now, I'm studying neuro and I want to say thanks, again!

[@ICUAdvantage]

Right on man. Yeah CV and Neuro are usually the toughest CC areas for people who don't normally work with those populations day in and day out. I do have some Neuro stuff, but definitely plans for a bit more after I do a good round of some CV related videos here soon.

[@joeadler5379]

My best friend committed suicide by gunshots.. they listed the cause of death as neurologic shock. The manner of death was suicide..

[@rokusvandendool4563]

I didn’t know about the hypothermia, that explains a lot. I’ve seen 2 patients in the emergency department who had spinal cord injury (one traumatic and the other inflammatory, myelitis transversa). Both were shaking so badly and they felt very cold. I didn’t understand it then, thought it was from the distress. Very interesting!

[@ICUAdvantage]

Always cool when you can see things that you have heard about. Makes it stick that much more! Glad you enjoyed the lesson.

[@beautifulspirits2402]

Amazing lesson thank you!

[@ICUAdvantage]

Glad you liked it!

[@flylittlebutterfly]

I love your videos!!! The contents are very organized and well explained. Thank you!

[@ICUAdvantage]

Thank you so much for this comment. I appreciate the feedback and glad to hear the video was well received!

[@jordane2036]

This is soooo helpful. Thank you so much.

[@ICUAdvantage]

I'm so glad! Youre welcome Jordan

[@tracynguyen6930]

Hi, at 1:33 you mentioned that CNS injury is at T6 and above. What do you mean by "above" here? as I think that the injury can be happened at anywhere across the spine right, not particular at T6? I am confused when with the phrase T6 and above here, can you please explain this? Thanks

[@ICUAdvantage]

I apologize for not making that more clear. The reason we worry about an injury at or above the T6 level (so any cervical level injury or T1-6) is because the efferent (from brain to organ) sympathetic nerve that enervates the heart giving us the ability to increase our heart rate and stroke volume is in the T1-T5 range. When the spinal cord injury impacts the ability for this signal to reach the heart, you run the risk of neurogenic shock. If the injury is below T6 then the efferent sympathetic nerve pathways would still be intact and not a problem. Hope that makes sense!

[@thelegendgamer33]

Sorry to reply to this after two years but I am very confused by this to some extent. If the major outflow is T5-T6, then if the injury were isolated to T6 would that retain some sympathetic tone? I'm asking if all tone to all organs (especially heart/ CVS) would be lost if any part of T1-T6 is lost, or does all of it have to be lost/ injured to cause neurogenic shock. I know its a specific questions but it's one I've had for ages because I'm trying to figure out exactly where it would have to be to definitely do harm. If it's only at T6 is some sympathetic splanchnic innervation presereved or does any lesion deny this function. Also I'm trying to visualise it but if the injury is at T1, is any function presevered as well? All the explanations I have received in class and from searching online just say T6 and above, but that's quite vague. It's important for me to have a precise clinical understanding, as I'm a student paramedic and we rely on clinical assessment + vitals + history pretty much exclusively - there is no radiological assessment we can perform etc

[@dgmnhn2098]

Thanks !

[@mohamedhabibberhanu6553]

Great job and great explanation

[@ICUAdvantage]

Thank you very much Mohamed!

[@arseniohardrick3123]

Loved it!

[@ICUAdvantage]

Awesome!

[@nazmuhammed8699]

Thank you omg

[@ICUAdvantage]

You're welcome!

[@GamerBoi-cz6cr]

what would you do for the hypothermia?

[@ICUAdvantage]

You would treat it with some sort of warming device. Typically a warming blanket is used.

[@imrantalha2746]

Good presentation, what about role of steroids Methylprednisolone in neurogenic shock.

[@julianaherzen3505]

why is parasympathetic innervation preserved but sympathetic is severed?

[@patriciaspaugy9288]

The parasympathetic nervous system reacts but gets stuck at T6-so anything above that does not react. It's like the top half of your body doesnt know what the bottom half is doing. The SNS and the PNS are not regulating together.

[@GrapeNelly]

Hey Eddie, or other subscribers/learners, why is it so important to rule out the other ones? There was a big stress on this but I didn't hear a rationale on and it might have just gone over my head

[@venkybly]

Tq

[@ICUAdvantage]

yw again :)

[@nadhila36]

the manifestation of neurogenic shock is hypothermi but why does the shock classify as warm shock?

[@ICUAdvantage]

Great question. The hypothermia more internal. Unlike the other shocks, neurogenic doesn’t have the vascular clamping down of extremity vessels giving the classic shock of cool, clammy skin. Instead the loss of vascular tone can lead to venous pooling and keeps extremities warm and dry, unlike other shock states. Hence the term “warm” shock.

[@ugonnanlemchukwu384]

@@ICUAdvantage Furthermore, the widespread massive dilatation leads to uncontrolled heat loos which is responsible for the warm skin. Recall, Blood carries inner body heat to the skin surface.

[@muyabinmgaza]

For dentists Neurogenic shock commonly occurs as vasovagal syncope (emotional fainting) .due to loss of vasomotor tone throughout the body, causing massive dilatation of veins.

[@ICUAdvantage]

Sounds similar, although here we are specifically referring to prolonged loss of vasomotor tone and thus a prolonged shock state as a result of spinal cord injury! Thank you for taking the time to comment and share!

[@anamsohail4466]

Kindly upload a new video on same topic... As in this one the entire thing is not visible... From mid video

[@ICUAdvantage]

What do you mean its not visible?

[@ICUAdvantage]

Just checked and it plays through fine for me. 🤷🏻‍♂️

[@MHairi-lj4dt]

How high should ourMAP targets be for these neurogenic shock patients? 🤔

[@ICUAdvantage]

We generally shoot for higher MAPs post spinal cord injury. Usually in the 85-90 range initially.

[@brendankelly483]

Sorry