Identifying What Type Shock | Shock (Part 9)

Summary

In this ninth and final lesson of a series on shock, Eddie Watson wraps up the topic by teaching how to identify different types of shock in patients. He introduces a chart comparing hypovolemic, cardiogenic (including obstructive), neurogenic, and septic shock, focusing on vital signs like heart rate, systemic vascular resistance, cardiac output, preload indicators, venous oxygen saturation, and skin appearance. The lesson aims to equip viewers with the tools to differentiate shock types, crucial for guiding appropriate treatment. Watson concludes by encouraging viewers to engage with the content and seek further information on shock and hemodynamics.

Takeaways

• 📚 The lesson is the ninth and final one in a series on shock, aiming to help identify different types of shock in patients.
• 👨‍🏫 The presenter, Eddie Watson, encourages viewers to subscribe to the channel and hit the bell icon for notifications on new lessons.
• 🔍 The lesson uses a chart to compare the four most common types of shock: hypovolemic, cardiogenic (including obstructive), neurogenic, and septic.
• 🚫 Anaphylactic shock is not covered as it is less common and similar to septic shock, with a few differences.
• 📊 The chart compares heart rate, systemic vascular resistance (SVR), cardiac output, preload indicators (CVP/Wedge Pressure), venous oxygen saturation (SVO2), and skin appearance.
• 🩸 Hypovolemic shock is characterized by increased heart rate and SVR, decreased preload indicators, cardiac output, SVO2, and cold clammy skin due to vasoconstriction.
• 💓 Cardiogenic shock features an increased heart rate, initially increased SVR which later hurts the heart, decreased cardiac output, elevated preload indicators, decreased SVO2, and cold clammy skin.
• 🌀 Neurogenic shock is marked by decreased heart rate, decreased SVR due to loss of sympathetic activity, possible decrease in cardiac output, decreased preload indicators, decreased SVO2, and warm dry skin.
• 🦠 Septic shock involves an initial increase in heart rate and cardiac output, profound drop in SVR, hypotension, and fluctuating skin temperature from warm/hot and dry to cold and clammy.
• 📈 The changes in SVO2 in septic shock can initially drop due to hypermetabolic state but later rise as oxygen cannot diffuse across swollen cell barriers.
• 🤝 Eddie Watson concludes the lesson series by hoping the information was useful and encourages feedback, questions, and likes for the channel.

Q & A

What is the purpose of the final lesson in the series on shock?

The purpose of the final lesson is to wrap everything up and provide tools to help identify or differentiate what type of shock a patient is experiencing.

Who is the presenter for the series of lessons on shock?

Eddie Watson is the presenter for the series of lessons on shock.

What are the four most common forms of shock covered in the script?

The four most common forms of shock covered are hypovolemic shock, cardiogenic shock (including obstructive shock), neurogenic shock, and septic shock.

Why is anaphylactic shock not included in the four common forms of shock discussed?

Anaphylactic shock is not included because it is not a very common type of shock encountered, and it often presents similarly to septic shock with a few differences.

What are the key indicators used to differentiate the types of shock?

The key indicators used to differentiate the types of shock include heart rate, systemic vascular resistance (SVR), cardiac output, preload indicators (CVP or wedge pressure), venous oxygen saturation (SVO2), and skin appearance.

How does the body compensate for decreased cardiac output in hypovolemic shock?

In hypovolemic shock, the body compensates by increasing the heart rate and systemic vascular resistance (SVR) to try and maintain perfusion.

What is the typical skin appearance in patients with cardiogenic shock?

Patients with cardiogenic shock typically have cold and clammy skin due to the sympathetic response and vasoconstriction.

How does the heart rate change in neurogenic shock?

In neurogenic shock, the heart rate decreases because the sympathetic innervation of the heart is lost while maintaining parasympathetic activity.

What happens to the systemic vascular resistance (SVR) in septic shock?

In septic shock, there is a profound drop in SVR due to the systemic inflammatory response and the release of mediators, leading to hypotension.

How does the skin appearance differ between early and late stages of septic shock?

In early septic shock, the skin may be warm or hot and dry due to fever and inflammation. In later stages, as the body constricts blood vessels, the skin can become cold and clammy.

What is the significance of the chart presented in the final lesson?

The chart is significant as it helps to compare different types of shock side-by-side, highlighting the differences in the body's responses, which can aid in identifying the underlying cause of shock in a patient.

What is the presenter's hope for the audience after completing the series on shock?

The presenter hopes that the audience found the series useful, gained a good understanding of the various types of shock, and that the information provided will help them in identifying and treating shock in patients.

Outlines

00:00

📚 Introduction to Shock Identification

Eddie Watson introduces the ninth and final lesson on shock, focusing on identifying the type of shock a patient is experiencing. The lesson aims to synthesize information from the series and provide tools for differentiation. A chart is presented to compare different types of shock, including hypovolemic, cardiogenic, neurogenic, and septic shock. The comparison includes heart rate, systemic vascular resistance (SVR), cardiac output, central venous pressure (CVP) or wedge pressure, venous oxygen saturation (SVO2), and skin appearance. The lesson excludes anaphylactic shock due to its rarity and similarity to septic shock.

05:02

🩺 Characteristics of Hypovolemic and Cardiogenic Shock

The script details the clinical signs of hypovolemic and cardiogenic shock. Hypovolemic shock is characterized by an increased heart rate and SVR due to compensatory mechanisms. It results in decreased preload indicators and cardiac output, leading to decreased venous oxygen saturation and cold, clammy skin. Cardiogenic shock also presents with an increased heart rate but may have a reduced ability to compensate due to heart disease. It features increased SVR, decreased cardiac output, elevated preload indicators, decreased SVO2, and cold, clammy skin due to vasoconstriction.

10:03

🧠 Neurogenic and Septic Shock Analysis

Neurogenic shock is distinguished by a decrease in heart rate due to the loss of sympathetic innervation and maintenance of parasympathetic activity. It involves decreased SVR, potentially stable or decreased cardiac output, decreased preload indicators, and decreased SVO2. Patients exhibit warm, dry skin due to the lack of vasoconstriction. Septic shock, driven by systemic inflammation, initially shows an increased heart rate and cardiac output as compensatory responses. However, it progresses to decreased heart rate, profound drop in SVR, hypotension, decreased preload indicators, and an initial drop followed by a rise in SVO2 due to cellular oxygen utilization issues. Skin temperature can vary from warm/hot and dry to cold and clammy as shock progresses.

📈 Conclusion and Summary of Shock Types

The script concludes by emphasizing the importance of recognizing distinct signs of different shock types to guide treatment. The chart presented helps differentiate between hypovolemic, cardiogenic, neurogenic, and septic shock based on physiological responses. Eddie Watson expresses gratitude for the viewers' engagement and encourages feedback and questions in the comments. The video also invites viewers to like the video, share their favorite parts, and explore other educational content on hemodynamics.

Keywords

💡Shock

Shock is a life-threatening medical condition where the body's tissues and organs do not receive enough oxygen and nutrients due to inadequate blood flow. In the video's context, it is the central theme, with the series focusing on understanding and identifying different types of shock. The script discusses various forms of shock, their causes, and how they affect the body.

💡Hypovolemic Shock

Hypovolemic shock is a type of shock that occurs when there is a significant loss of blood or fluids in the body, leading to inadequate blood volume and reduced blood pressure. The script explains that in hypovolemic shock, the heart rate increases as a compensatory mechanism, systemic vascular resistance (SVR) also increases, and preload indicators decrease due to lack of blood volume.

💡Cardiogenic Shock

Cardiogenic shock is caused by the heart's inability to pump blood effectively, often due to severe heart disease. The script mentions that in cardiogenic shock, there is an initial increase in heart rate and SVR as compensatory responses. However, these mechanisms can be counterproductive as they increase the workload on an already weak heart, leading to a drop in cardiac output.

💡Obstructive Shock

Obstructive shock occurs when there is an obstruction in the circulation that prevents blood from reaching the heart. Although not explicitly detailed in the script, it is grouped with cardiogenic shock as they share similar presentations, such as increased SVR and decreased cardiac output.

💡Neurogenic Shock

Neurogenic shock is a type of distributive shock caused by a loss of autonomic nervous system function, often due to spinal cord injuries. The script explains that in neurogenic shock, there is a decrease in heart rate due to the loss of sympathetic innervation and an increase in parasympathetic activity, leading to vasodilation and decreased SVR.

💡Septic Shock

Septic shock is a severe form of distributive shock that occurs in response to a systemic infection. The script describes it as having an initial increase in heart rate and cardiac output as compensatory responses, but eventually leading to profound vasodilation, hypotension, and a decrease in SVR due to the body's inflammatory response.

💡Systemic Vascular Resistance (SVR)

Systemic vascular resistance is a measure of the resistance to blood flow within the systemic circulation. The script uses SVR to illustrate how the body compensates in different types of shock, such as increasing SVR in hypovolemic and cardiogenic shock to maintain blood pressure, while in septic shock, SVR decreases due to vasodilation.

💡Cardiac Output

Cardiac output refers to the volume of blood pumped by the heart per minute. The script discusses how cardiac output is affected in various types of shock, with initial compensatory increases in some forms and eventual decreases as the shock progresses and the heart's function is compromised.

💡Preload

Preload in the context of the heart refers to the amount of blood returning to the heart and stretching the cardiac muscle before contraction. The script explains that in hypovolemic shock, preload indicators decrease due to blood loss, while in cardiogenic shock, they increase due to blood backing up because the heart cannot pump effectively.

💡Venous Oxygen Saturation (SVO2)

Venous oxygen saturation is a measure of the amount of oxygen remaining in the blood after it has circulated through the body. The script uses SVO2 to illustrate the body's oxygen utilization in different types of shock, with decreases seen in hypovolemic, cardiogenic, and neurogenic shock due to slow blood flow and increased oxygen extraction by cells.

💡Skin Signs

Skin signs refer to the changes in the appearance and feel of the skin that can indicate underlying health conditions. The script describes how the skin can be cold and clammy in hypovolemic, cardiogenic, and septic shock due to vasoconstriction, while in neurogenic shock, the skin is warm and dry due to the lack of sympathetic response.

Highlights

Introduction to the ninth and final lesson on shock, focusing on identifying different types of shock.

Eddie Watson presents the lesson and encourages subscribing to stay updated with new releases.

Overview of the series, covering basics of shock and body's response, stages, and types of shock.

Introduction of a chart to compare different types of shock and their signs.

Explanation of the four most common forms of shock: hypovolemic, cardiogenic, neurogenic, and septic.

Hypovolemic shock characterized by increased heart rate and SVR, decreased preload indicators, cardiac output, and venous oxygen saturation.

Cardiogenic shock involves attempts to compensate with increased heart rate and SVR, but leads to decreased cardiac output and preload indicators.

Neurogenic shock is marked by decreased heart rate, SVR, and preload indicators, with warm dry skin due to lack of sympathetic response.

Septic shock involves an initial increase in heart rate and cardiac output, but leads to profound drops in SVR and preload indicators.

Venous oxygen saturation (SVO2) decreases in all shock types due to slow blood flow and increased oxygen extraction by cells.

Skin changes in shock: cold clammy in hypovolemic and cardiogenic, warm dry in neurogenic, and varying in septic.

Chart comparison to identify shock types based on heart rate, SVR, preload indicators, cardiac output, SVO2, and skin appearance.

Discussion on the importance of recognizing shock types for guiding treatment.

Conclusion of the shock series and a call for feedback and questions from viewers.

Invitation to like the video, comment, and subscribe for more educational content.

Link provided to access the playlist of shock lessons and other educational series on hemodynamics.

Transcripts

you

[Music]

all right everybody welcome back to this

ninth and final lesson in our series of

lessons on shock in this lesson we are

gonna wrap everything up and talk about

the different ways to identify what type

of shock your patient is in my name is

Eddie Watson and I am gonna be your

presenter for this series of lessons and

as always in order to stay up to date on

our latest lessons make sure and

subscribe to our channel below don't

forget to hit that Bell icon though in

order to get those notifications when we

release the new lessons alright so we

have made it all the way through this

series of lessons we've covered

everything from the basics of what shock

is and how our body responds to it we

talked about the different stages of

shock as well as we did a deep dive into

each one of the different types and

causes of shock and so finally for this

last lesson I want to bring it all

together and put it all in one spot and

really give you some tools in order to

help you be able to identify or

differentiate what type of shock your

patient is in so in order to do that I

have a chart that I put together here

and what we're gonna do is we're gonna

use this chart in order to compare the

different types of shock as well as some

of the signs that you would see and

really be able to compare these

side-by-side and see where some of these

differences are in order to be able to

help you to pinpoint or identify what

that underlying cause of shock is now

for this I'm only gonna cover the four

most common forms of shock that that

you're gonna encounter

but really if you review through the

past lessons and really get an

understanding and an idea of what's

going on with each type of shock you

really should be able to identify what's

going on or potentially what that type

of shock is that's that's causing the

shock state for your patient oh right

and so these four types of shock that we

are going to cover here the first one is

going to be our hypovolemic

the next one is going to be our

cardiogenic but this is also going to

include our obstructive shocks that we

talked about as these for the most part

present themselves in the same way as

cardiogenic shock the next of these

types of shock is going to be our

neurogenic which if you remember is one

of our types of distributive shock and

finally the last one that I'm going to

talk about is septic shock again another

form of distributive shock you'll see

that I do not have anaphylactic shock on

here and really this is not a very

common type of shock that you're likely

to encounter and a lot of it really

looks a lot like what you'd see in

septic shock

with a few differences all right so when

talking about each of these types of

shock we're gonna look at what you would

expect to see with the patient's heart

rate with their systemic vascular

resistance with their cardiac output

with their CVP or wedge pressure really

an indication of our preload our venous

oxygen saturation and finally how does

their skin look and feel all right so

the first one that we are going to talk

about is hypovolemic shock and with

hypovolemic shock and so when we look at

our patient's heart rate the body is

going to be attempting to compensate in

order for that decreased cardiac output

and that decreased perfusion by

increasing our heart rate and often

times you'll see a pretty sizable

increase in heart rate now when we look

at our SVR again our body is working to

try and compensate for that decreased

cardiac output and decreased perfusion

so again we're gonna see our body look

to increase our systemic vascular

resistance with that squeeze and

ultimately we're going to see a pretty

markedly increase in our SVR now I'm

gonna skip past one here for just a

minute and go on and talk about our

preload indicators and since we know our

preload is a result of blood returning

back to the heart in the case of

hypovolemic shock we don't really have

blood or volume to return back so we're

gonna see a decrease in our preload

indicators as a result of all of this

you are gonna see a decrease in your

cardiac output and while the body may

attempt to compensate and make up for

this and profound states of hypovolemic

shock it's just not going to be able to

so now when we look at our venous oxygen

saturation due to the decreased

perfusion it's going to take longer for

that blood to work its way back to the

heart and so the cells are going to be

using up more of that oxygen that is in

the blood and so we're actually going to

see a decrease in our venous oxygen

saturation and finally when we look at

our patients skin due to the

compensation mechanisms and that

sympathetic response we are gonna get

that vasoconstriction as we saw with the

increased SVR and this is going to lead

to our patients having that cold clammy

skin all right so moving on to

cardiogenic shock again when we look at

the heart rate the body is going to

attempt to compensate for our decreased

blood pressure and so we will see an

increase in our heart rate now sometimes

in the case of some pretty diseased

hearts the heart may not be able to

compensate quite as much as we would see

in other forms of shock this will also

lead to an attempted compensation with

our vasoconstriction and our increase in

our SVR as the body attempts to increase

that flow of blood back to the heart but

this is where we find an example of a

compensation mechanism that actually is

going to hurt us in the end because in

the case of cardiogenic shock we have a

weak heart that is not able to it's not

able to pump that blood forward and so

by increasing that systemic vascular

resistance we're actually making it more

difficult for that heart to beat and so

as a result along with the fact that our

heart is just not doing well we're gonna

see a drop in cardiac output and

sometimes a pretty profound drop in that

cardiac output now when we look at our

preload indicators the biggest problem

in cardiogenic shock is the heart is not

able to

that blood forward it's unable to push

that blood forward and so as we talked

about things begin to back up throughout

the system and so you're actually gonna

see an elevation in your preload

indicators whether that be here

pulmonary capillary wedge pressure or

your central venous pressure or your CVP

and in addition when we look at our

venous oxygen saturation again that

blood is moving slowly throughout the

system so the cells are gonna be

extracting more oxygen from the blood

that is available and so we're gonna see

that decreased svo2

and once again as a part of that

compensation mechanism and the phase of

constriction we are again gonna see that

cold clammy skin in our patient alright

so looking at neurogenic shock when we

talk about our heart rate as we talked

about we no longer have that sympathetic

innervation of the heart while

maintaining our parasympathetic activity

and so we are actually going to see a

decrease in our heart rate as our body

is unable to compensate for any changes

in our blood pressure in addition to

that we've also lost our sympathetic

activation and our vascular

vasoconstriction so we are gonna see a

decrease in our SVR for our cardiac

output we may see it stay about the same

but also due to other factors going on

we may also see a decreased cardiac

output and again looking at our preload

indicators and again with our neurogenic

shock we have massive vasodilation and

that blood is pooling and not making its

way back to the heart so we are gonna

see a decrease and our preload

indicators and again just like in these

last couple forms of shock the body is

gonna be extracting more oxygen from the

blood that is slowly making its way

through the system so we are gonna see a

decrease in our svo2 now finally like we

talked about with the patient's skin we

don't have that vasoconstriction going

on as a part of that sympathetic

response so your patients actually gonna

have warm dry skin all right and so on

to our final type of shock with septic

shock when we look at our patients heart

rate like we talked about initially the

body is going to attempt to compensate

for what's going on and we'll see that

elevation in our heart rate but as the

shot goes on as we continue to do damage

to end organs and vessels and continue

to increase the swelling around those

cells we may eventually see a decrease

in heart rate now when we take a look at

our SVR one of the biggest things with

septic shock is that profound systemic

inflammatory response and releasing of

all of those mediators and so you are

gonna have a profound drop in your SVR

and a profound hypotension as a result

now for the cardiac output this is going

to be very much just like we talked

about with the heart rate initially

we're going to see the body compensate

and increase that cardiac output but

even more so than we would see in the

heart rate changes as time goes on and

things progress we will definitely see a

decline in cardiac output as a result of

that profound vasodilation we are just

not going to be able to get that blood

back to the heart and again as a result

of those leaky vessels we're gonna have

even less blood returning or less volume

returning and so you oftentimes will

have a pretty profound drop in your

preload indicators and then when we talk

about our svo2 and our bodies and

tissues ability to utilize oxygen

initially early on we are gonna see a

drop in our svo2 and again we can have

that hyper metabolic state that can

really profoundly drop it but once again

as time goes on and we continue to have

that swelling around the cells and that

oxygen just cannot diffuse across that

barrier we begin to see a rise in our

svo2

and again this can lead to a pretty

profound rise as our body is just not

able to to make use of the oxygen that

is available to it and finally when

looking at our patient's skin like we

talked about due to the fever and the

inflammatory process your patient is

going to have initially a warm or even

hot skin that's going to be dry but as

that shock state continues and we

continue to our body continues to

Ryann days Oh constrict and clamp down

those blood vessels you will eventually

see cold clammy skin alright and so as

you can see when you take a look at this

chart you can see some very distinct

differences in how our body responds to

the different types of shock that a

patient may find themselves in as a

result there's often some very telltale

signs that can be a good indicator of

what type of shock your patient is in

and can help - that can help to guide

the various types of treatment that we

would do for them so I really hope this

chart helps to explain that and show

that to you so that you can really be

able to differentiate you know what type

of shock is going on and what you would

be seeing in your patients and with all

of that said this also concludes the the

last lesson in our series of shock I

really truly hope that you found this

series and these lessons useful and that

you were able to get some good

information from this and to have a good

understanding of what's going on with

these various types of shock and what

your patient may be going through it has

absolutely been my pleasure to go

through all this information with you

guys and as always I truly thank you for

watching and I really hope that you

found this informative if you liked what

you saw and you did find it useful

please hit that like button below as it

does help support our channel and in the

comments below tell us your favorite

part of this video or really any video

in this series as well as feel free to

ask any questions that you might have

and finally I'll include a link down at

the bottom that will take you to the

playlist that will have all these

lessons on choc as well as feel free to

check out another one of our great

series of lessons on hemodynamics and as

always I really thank you for watching

and we'll see in the next series of

lessons