Cardiogenic shock | Circulatory System and Disease | NCLEX-RN | Khan Academy
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- čas přidán 23. 11. 2014
- Created by Ian Mannarino.
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Each within this entire series is excellent info and I hope all listen and learn from the sequence. Blessings thank you.
Reviewing all of the different kinds of shock to review for my medic test 👍😁 thanks.!
First, be careful not to conflate pulmonary venous congestion (high PCWP) with cardiogenic shock (insufficient CO and MAP to adequately perfuse organs); although they frequently coexist, they don't always. Also, in cardiogenic shock, SVR is usually already quite elevated as part of the body's attempt to restore normal blood pressure in the face of the failing heart. As pointed out by other viewers, vasopressors (at least pure vasopressors) are a bad idea since they will increase the work of the heart further, leading to worsening of cardiac output and worsening of symptoms/signs of congestion. Instead, the foundations of treatment of cardiogenic shock are inotropes (which increase contractility), vasodilators (which LOWER SVR), and usually diuretics depending on volume status (which lower preload). Although fixing the underlying problem may sound like a great idea, performing a valve replacement on someone actively in cardiogenic shock carries a substantial risk of death.
actually, Dr Eric I agree with you(I regularly follow your videos).
but, in cases of severe hypotension and organ hypoperfusion, there is no choice but to start low dose Noradrenalin just to maintain an acceptable MAP... until you can insert an IABP or even better get the coronaries flowing if ischemia is the cause...
in hypotension you can start neither dobutamine nor levosemendan or for that matter neither a PD5#... coz they all will cause further hypotension... starting norepi followed by a mechanical assist device and definitive treatment will help... and you can taper the norepi as soon as you can.
+Darshan Jani also, norepi will get the "unstressed" volume from the venous side into circulation so more blood will flow instead of pooling
+Darshan Jani Thanks for the response. In the event that a patient is in cardiogenic shock which is accompanied by severe hypotension to the point that dobutamine would not be tolerated (which is not always the case in cardiogenic shock), the pressor of choice is controversial. In 2016, most crticial care docs and anesthesiologists would follow the results from the SOAP II trial (www.nejm.org/doi/full/10.1056/NEJMoa0907118), which appeared to show that dopamine may be associated with worse outcomes as compared to norepinephrine (noradrenaline) when used in cardiogenic shock likely on account of higher rates of arrhythmias. However, most cardiologists I know honestly don't believe SOAP II.
The 2 major criticisms of the trial (which I think are very valid) are:
1. That dopamine and norepinepherine doses uesd in the trial were chosen to be equipotent for their alpha adrenergic effects, which would result in relatively higher beta adrenergic effects for dopamine (and thus increased arrhythmia risk) since dopamine has more beta agonist activity than norepinepherine.
2. The trial did not report the frequency or timeliness of the PCI, CABG, or IABP placement. Since most cardiogenic shock is in the setting of an acute MI, those interventions are actually the primary treatment, and not pressors. As you indicated above, pressors (irrespective of specific pressor choice) are just to buy time to get these more definitive therapies. If the centers in the trial did a poor job at getting these procedural interventions quickly, and especially if there was a difference in the timeliness between the dopamine and norepi groups, it would completely invalidate the trial. Since this issue was inexplicably not reported, the trial as is should be taken with a huge "grain of salt".
+Eric Strong I am a Critical Care specialist :-)
i would use Dopamine only on someone who has bradycardia with hypotension. that too coz I don't trust phenylephrine :-)
otherwise its NORAD all the way for me. I agree SOAP 2 may not be perfect but their results match my day to day experience.
Why would you use Neo on a patient that is already brady? Doesn't it often result in a reflex bradycardia? Not meaning any disrespect, I'm truly curious if I'm missing something here
Thank you. So clear and straight fwd.
What a great explanation 😮😮
thank you very much❤❤
Thank you so much for this! Made nursing life simpler
i love how u explain everything
Awesome! Thank you!
I have this, and I faint every now and then. LOL. To me, it's being funnier over time. 😂
your pronunciation of angina was classic haha, I've only ever heard it as "Anne-j-eye-na" never heard "Anne-gin-a" as in a bottle of Gin before.
I was going to say the same thing, Eric Strong. Vasopressers are not a good idea because the heart is already having a hard time pumping and that would likely make it more difficult.
Reading the comments about controversy of giving pressors....from my own nursing lecture at school, you would give vasopressors although it seems like a contraindication because you'd be giving fluids if the patient is experiencing cardiogenic shock. If the vessels are super dilated, the fluids don't stay in, hence the vasopressors to constrict and try to keep fluids in.
I'm not well-versed yet with drugs, but the way I make sense of it is that vasopressors (maybe even systemic i.v. drugs such as epinephrine) *only* constricts the main arteries. Capillaries are mostly unaffected so perfusion may be restored since O2 and blood delivery is faster to end organs/limbs
Also at 4:42 in the video you highlight the "pulmonary veins" in your heart diagram with yellow lines, you've actually drawn the lines around the pulmonary arteries, not the veins (which carry blood back to the heart)
Just commenting on the first few seconds, "The heart is a very beautiful organ". It made me spit out some of the water I was drinking d/t laughing because it sounded like a very nerdy way of describing a Victoria's Secret model. Nope, just internal body organs lol. I'm sure the video will be excellent and very helpful, though :)
I love it when you are able to have all your drawing in one screen.
i know it is kind of randomly asking but do anybody know of a good website to stream newly released movies online ?
@Leighton Emerson Meh I watch on flixportal. you can find it on google :D -lochlan
@Lochlan Rodrigo thanks, I signed up and it seems to work :D I appreciate it !
@Leighton Emerson Glad I could help xD
Vasopressors vasoconstrict...that decreases amount of blood in systemic circulation. Increased SVR is a compensatory mechanism so blood shunts to the vital organs, so probably not best to further increase resistance as a part of treating decreased systemic circulation.
agreed, but if.you have a ridiculously low MAP, it does make sense to start a vasopressor - why?
(1) organ perfusion depends neither on systolic nor on diastolic pressure alone but the Mean arterial pressure. adding norepinephrine will ensure that adequacy of MAP until you can get a mechanical assist device in or treat the cause of the cardiogenic shock.
(2)Norepi in low dose will bring into circulation the pooled venous blood by changing unstressed volume into stressed volume which may(or may not) help
thank you for the explanation and study, Currently someone close to me is suffering from this and surely a dark and hard time for me.
Um...yes on the Inotropes. NO on pushing pressors. Don't give a heart more work when it is already failing. CO is already often compromised due to PVR as one element of the problem.
kylesgonegolfin u have it backwards in the case of "shock" there is poor venous return due to the vessels being over dilated and leaking into the extravascular space. Shock is basically poor perfusion. So when the tissue has excess fluid then the oxygen will not reach the tissue. Pressors restricts the vessels to hold on the it's current fluid volume to get it back to the heart then perfuse and then send it back out. Giving an inotrope into a leaky vessel wouldn't solve the issue since the volume is loss.
@@lukejames411 this is true, not only inotropes can be given because there might be a cardiogenic shock with excessive blood vessel dilation, I think it all depends on the baseline symptoms of the shock.
Vasopressors are still very useful in cadiogenic shock because the heart is failing to provide the driving force of the blood in vessels hence vasoconstriction by these pressors is helpful in providing that driving force.
this v is support many students
Very well explained. Can you please post video on STAGES OF SHOCK ( if possible ). Thanks
Awesome
At 9:22, it says that vasopressor is used to increase O2 supply.....How is it possible to increase perfusion by constricting a blood vessel?.....What I know is constricting a blood vessel produces ischemia as constricted vessel carries lesser blood and thus carries lesser O2 than a dilated one......Also, by constricting a vessel we are increasing SVR which means there will be an increase in afterload as heart is going to have hard time to pump against increased peripheral resistance.......This doesn't seem to be of any help to a heart which has already failed in pumping blood.......So, what is the point of giving a vasopressor in cardiogenic shock?........A selective veno-constrictor would make sense though.....PLEASE HELP!
Ashutosh Upadhyaya I think the goal is to increase overall systemic vascular pressure because you want to maintain perfusion to the rest of the body. The heart will not have a hard time pumping against this resistance because we are merely trying to restore the natural systemic vascular resistance. During shock the SVR is way too low
Great 🥰🥰🥰
what is the prognosis for a patient 77 years old with heart failure and e.f. 30% in case of cardiogenic shock? thank you.
hi i have kind of suggesting or a request could you please put a translation to french language (by writing ) is it possible!?
You are magnificent
Kobe 💛💜
RIP kobe
tihs ones is the cause of death of my grandmother
OK. I am a little concern with people here saying not to use pressors....UMMM? Now it is a good idea to go back to the guidelines and then come back and comment.
+Jose E Diaz I think you may be conflating the terms "pressors" and "vasopressors". "Pressors" is a colloquial term which includes both vasopressors (which act primarily by increasing SVR, and thus, MAP) and inotropes (which act primarily by increasing contractility, and thus CO; inotropes may or may not increase BP). In cardiogenic shock, inotropes should be the focus of pharmacological therapy, not vasopressors.
As a nurse, it would be more beneficial if you list common drugs used as opposed to calculations and formulas that aren't commonly used. Just saying. NCLEX wouldn't really ask that...regardless, the info here is very questionable. I'll stick to my book on this one and highly suggest revision as other people have commented.
Sir voice not audible please increase the volume