Identifying What Type Shock | Shock (Part 9)
Summary
TLDRIn 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
- π The lesson is the ninth and final one in a series on shock, aiming to help identify different types of shock in patients.
- π¨βπ« The presenter, Eddie Watson, encourages viewers to subscribe to the channel and hit the bell icon for notifications on new lessons.
- π The lesson uses a chart to compare the four most common types of shock: hypovolemic, cardiogenic (including obstructive), neurogenic, and septic.
- π« Anaphylactic shock is not covered as it is less common and similar to septic shock, with a few differences.
- π The chart compares heart rate, systemic vascular resistance (SVR), cardiac output, preload indicators (CVP/Wedge Pressure), venous oxygen saturation (SVO2), and skin appearance.
- π©Έ Hypovolemic shock is characterized by increased heart rate and SVR, decreased preload indicators, cardiac output, SVO2, and cold clammy skin due to vasoconstriction.
- π 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.
- π 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.
- π¦ 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.
- π 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.
- π€ 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
π 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.
π©Ί 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.
π§ 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.
π 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.
Mindmap
Keywords
π‘Shock
π‘Hypovolemic Shock
π‘Cardiogenic Shock
π‘Obstructive Shock
π‘Neurogenic Shock
π‘Septic Shock
π‘Systemic Vascular Resistance (SVR)
π‘Cardiac Output
π‘Preload
π‘Venous Oxygen Saturation (SVO2)
π‘Skin Signs
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
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[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
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