Awesome as the younger set would say. The presenter has a way of speaking that the listener feels at ease and waits for more. He goes at a pace that can be absorbed and if not, there’s always the rewind button. At 83, if I could do life over again, medicine would be high on my list of vocation choices.
I'm in no way related to medical field (photographer) - but stumbled on this late at night haha. Very interesting video, and you did a great job of explaining boring medical stuff in an interesting way. Good work, and thank you!
You explained how the skin is warm with septic shock, due to massive vasodilation, but in septic shock the patient often also has a fever, which would also make the skin very warm. Love your lectures, listened to many of them. Will listen to all of them. Pertains to my work as an RN on a chronically critically ill unit (LTACH).
The skin temperature metric also doesn't capture the full picture for some sepsis patients. A few can have normal or high temperature in the preliminary stages.
I can personally tell you from life experience septic shock sucks bp of 50/40 combined with sepsis sucks i live to tell the tail when I have cvid a form of primary immunodeficiency disease mixed with class iv heart failure.. cards stacked against me
Bro I understood like 10% of this video. Still super interesting though, thanks for making it. The more you learn the more you realise how many things there are that other people know but you don't.
At age 55, I had HA double pneumonia and HA septic shock due to medical malpractice. It completely destroyed my (prior to that time) good physical and mental health and, thus, my life. Every organ (except my liver) was damaged and I have PTSD related to how this happened. (The original issue was a kidney stone that my body passed on its own.) The ICU doctors told my family I was not expected to survive. I am convinced God saved my life, but I still do not know for what reason because I suffer daily and have more diagnoses than even I can believe (and I am living it.) There seems to be nothing medicine can (or is willing to) do to undo what they did '(e.g., enlarged heart, myocarditis, stage III CKD, etc etc etc)
My mother has been sick for over a week now - she is being treated in ICU - doctors havent been able to close in on the root cause reports indicated a lower haemoglobin level around 6 - and a higher procalcitonin level - suspicious of Sepsis would you share any suggestions please - her symptoms include sporadic chills and shivering (very severe) - sudden temperature, vomiting, dizziness and fatigue.
I lost my father on Nov 19 , from that moment onwards i am trying to understand what went wrong . He was a diabetic and had a wound in his leg, eventhough i believe there could be a better treatment that would have saved his life 😣
I love watching these videos even though some are far over my head. Thanks for the education. Know anyone that does these for politics? In an unbiased way?
I find Vox to be good at breaking down complex political issues. They may sometimes lean to the left in their opinion pieces, but they still do their best to stick to the facts.
Great way to teach this. I do it a different way but it's similar and you mentioned some things I had not thought to talk about. Clarification though. Hypovolemic shock can be caused by anything that causes a loss in fluid. So, severe vomiting/diarrhea is another etiology. Also, I always learned the PAWP represents left ventricular end-diastolic pressure, not pressure in the left atria. And since preload is the stretch in the right ventricle it makes great sense it is also measured by the pressure in the left ventricle (the most important chamber). Do I have this wrong? Finally, you were explaining the "warm shock" early phase of septic shock, but did not (likely out of simplicity-sake) mention the "cold shock" that subsequently develops. I'd never heard about the arterial dysfunction; so, that helps explain the flushed skin. Thank you!
I think he talked about the wedge pressure and left atria because if the pressure increases in the left ventricle at the end of diastole (you described it the way I learned it- as the left ventricular end-diastolic pressure), it would make sense that the left atria would subsequently have a higher pressure, too. It could be described that way in his video for the sake of simplicity. Preload, as it is the degree of stretch in the right side of the heart prior to contraction (essentially, it's directly related to the volume returning to the heart) is measured by the CVP as far as I understand it. From your description of the right and left ventricular pressures, it sounds like you're discussing more the concept of afterload (the pressure required to eject blood from the left ventricle) rather than preload. I agree about the warm/cold shock- he probably just omitted the later cold phase to help med/nursing/science students understand the main initial differences in the three types he discussed. he could have also talked about neurogenic shock which would have thrown some of the compensation stuff in a wonky direction (low hr AND low BP)...! As far as I understand also- some of the warmth the comes along in the warm phase is related to glycogenolysis in the liver so that the body can have a fresh supply of glucose to use where needed for compensation. This would cause the warm/flushed appearance r/t hyperglycemia in that stage of shock- once the glucose stores are gone and the originating cause isn't dealt with, the cool/clammy progressive shock follows (the cold shock you mention).
Also, think of the massive vasodilation in septic shock as a "relative" hypovolemia. I teach my students that it's like a 5 gallon fish tanks with 5 gallons of water. Then when septic shock hits, you put that water in a 10 gallon fishtank. You didn't lose water, but the container increased dramatically. You lose volume which is preload, which is RVP/PCWP.
Sudharshan vignesh the heart can't pump the blood like it should. The blood is basically backing up causing higher pressures in these readings that you mention
Thanks for the question. In cardiogenic shock the heart can't pump blood forward effectively. Left heart failure causes an elevation in pressure in the Left Atrium which is transmitted back to the pulmonary veins and shows up on the PCWP. Similarly, right heart failure increases the pressure in the right atrium and elevates JVP. Decreased forward output is certainly one cause of a low blood pressure.
Ok perfect that you explained all this BUT I want you to explain when a nurse contaminates a patient with MRSA, how and why? Because there suppose to be careful and change their gloves and wash their hands. No one is giving me answers. Please tell me what happens to a patient with blood clots in their lung's. With this coronavirus we need no educate ourselves also. Thank you and God bless you all
![ได้เวลา! พาน้องแฝดฉีดวัคซีนครบ 1 เดือน🫣 [cc] แดนแพทตี้ SS2 | EP.52 |](http://i.ytimg.com/vi/IzeLtaXBLNE/mqdefault.jpg)
Awesome as the younger set would say. The presenter has a way of speaking that the listener feels at ease and waits for more. He goes at a pace that can be absorbed and if not, there’s always the rewind button. At 83, if I could do life over again, medicine would be high on my list of vocation choices.
as a nursing student, i have literally watched every single one of your videos. could not be more stoked for remasters
I'm in no way related to medical field (photographer) - but stumbled on this late at night haha. Very interesting video, and you did a great job of explaining boring medical stuff in an interesting way. Good work, and thank you!
You explained how the skin is warm with septic shock, due to massive vasodilation, but in septic shock the patient often also has a fever, which would also make the skin very warm. Love your lectures, listened to many of them. Will listen to all of them. Pertains to my work as an RN on a chronically critically ill unit (LTACH).
I’m a Respiratory Therapy student and I love all of your lectures.
Thank you Dr. Seheult!
Júst watch the video.
Septic shock symptoms and overviews .
I guess hair follicles are also non vital organs.
That must be sometimes a reason for sudden hair loss after shock situation.
WOW. this was so straightforward and easy to follow
The skin temperature metric also doesn't capture the full picture for some sepsis patients. A few can have normal or high temperature in the preliminary stages.
I can personally tell you from life experience septic shock sucks bp of 50/40 combined with sepsis sucks i live to tell the tail when I have cvid a form of primary immunodeficiency disease mixed with class iv heart failure.. cards stacked against me
Bro I understood like 10% of this video. Still super interesting though, thanks for making it. The more you learn the more you realise how many things there are that other people know but you don't.
During hypovolemic shock, are there any factors that could cause the blood pressure to be higher than what you expect?
Skin isn't a vital organ? This guy isn't afraid UVB rays or BCC...
I wish my nursing professors taught like you do
My grandfather died to septic shock, and I just really wanted to know what it was, it's pretty scary isn't it
Thank you for explaining shock concisely! I was wondering if you will make videos explaining the ENDOCRINE system.
Very simple and direct, thank you Doc
Thank you for the feedback!
Very.excellent.lecture.thank.you.sir.
your videos are fantastic but could someone explain how the EF could go up with a simultaneous reduced CO?
I overheared my mom say something like this after a checkup...
I REALLY REALLY do hope it is just something else than what i am thinking
This is brilliant!!! Once again, thank you!
At age 55, I had HA double pneumonia and HA septic shock due to medical malpractice. It completely destroyed my (prior to that time) good physical and mental health and, thus, my life. Every organ (except my liver) was damaged and I have PTSD related to how this happened. (The original issue was a kidney stone that my body passed on its own.) The ICU doctors told my family I was not expected to survive. I am convinced God saved my life, but I still do not know for what reason because I suffer daily and have more diagnoses than even I can believe (and I am living it.) There seems to be nothing medicine can (or is willing to) do to undo what they did '(e.g., enlarged heart, myocarditis, stage III CKD, etc etc etc)
Pretty sure ABG is also managed in ICU sepsis patients too.
This was great! Thank you.
Best shock explanation ever 👍🏼
This was great, thank you.
Another great video. Many thanks.
Wonderful
But short talk😔
I’ve seen it more than once
My mother has been sick for over a week now - she is being treated in ICU - doctors havent been able to close in on the root cause
reports indicated a lower haemoglobin level around 6 - and a higher procalcitonin level - suspicious of Sepsis
would you share any suggestions please - her symptoms include sporadic chills and shivering (very severe) - sudden temperature, vomiting, dizziness and fatigue.
i have watched ur previous series in shock. just wondering what changes have you made.
For this particular video, we mostly sped up the illustrations to shorten the overall video time.
Fantastic video 💜
I'm just a writer trying to understand shock for writing purposes and the way you explain it even I can understand, no med experience necessary!
Shouldn't the tissue perfusion discussion also include the inability to remove CO2 and other waste products? It only covers O2.
Brilliant explanation; many thanks for sharing.
My Dad died of Septecemia on April 19 💔
I'm sorry for your loss. What was the cause? My stepdad had pneumonia...
I lost my father on Nov 19 , from that moment onwards i am trying to understand what went wrong . He was a diabetic and had a wound in his leg, eventhough i believe there could be a better treatment that would have saved his life 😣
good presentation
thank you. simple, clear, and concise.
No mention of IL2 and IL10 with the cytokines?
I survived Necrotizing fasciitis.
I'm here because of Jan Catherine Sy 🙏
Very good
I love watching these videos even though some are far over my head. Thanks for the education. Know anyone that does these for politics? In an unbiased way?
MadameCasper Crash Course or Khan Academy
I find Vox to be good at breaking down complex political issues. They may sometimes lean to the left in their opinion pieces, but they still do their best to stick to the facts.
Great way to teach this. I do it a different way but it's similar and you mentioned some things I had not thought to talk about. Clarification though. Hypovolemic shock can be caused by anything that causes a loss in fluid. So, severe vomiting/diarrhea is another etiology. Also, I always learned the PAWP represents left ventricular end-diastolic pressure, not pressure in the left atria. And since preload is the stretch in the right ventricle it makes great sense it is also measured by the pressure in the left ventricle (the most important chamber). Do I have this wrong? Finally, you were explaining the "warm shock" early phase of septic shock, but did not (likely out of simplicity-sake) mention the "cold shock" that subsequently develops. I'd never heard about the arterial dysfunction; so, that helps explain the flushed skin. Thank you!
I think he talked about the wedge pressure and left atria because if the pressure increases in the left ventricle at the end of diastole (you described it the way I learned it- as the left ventricular end-diastolic pressure), it would make sense that the left atria would subsequently have a higher pressure, too. It could be described that way in his video for the sake of simplicity. Preload, as it is the degree of stretch in the right side of the heart prior to contraction (essentially, it's directly related to the volume returning to the heart) is measured by the CVP as far as I understand it. From your description of the right and left ventricular pressures, it sounds like you're discussing more the concept of afterload (the pressure required to eject blood from the left ventricle) rather than preload. I agree about the warm/cold shock- he probably just omitted the later cold phase to help med/nursing/science students understand the main initial differences in the three types he discussed. he could have also talked about neurogenic shock which would have thrown some of the compensation stuff in a wonky direction (low hr AND low BP)...! As far as I understand also- some of the warmth the comes along in the warm phase is related to glycogenolysis in the liver so that the body can have a fresh supply of glucose to use where needed for compensation. This would cause the warm/flushed appearance r/t hyperglycemia in that stage of shock- once the glucose stores are gone and the originating cause isn't dealt with, the cool/clammy progressive shock follows (the cold shock you mention).
Hi Prof, is central venous catheter insertion useful in assessing right heart pressure?
Yes, it is
Thank you Prof
I see the original video, and this one... but where is video 2? I'm curious to see how shock is treated!
The entire Shock and Sepsis series is available on our site: www.medcram.com/courses/shock-and-sepsis-explained-clearly
So when people skin goes yellow, does that mean more blood is being distributed to the vital organs.
I ended up in hospital for 6 weeks and had sepsis
Outstanding teacher
Can someone please explain why in septic shock PCWP and RVP are decreased with an increase in CO. Thank you!
+Elger Montesclaros because resistance is reduced. If the pipe is bigger you conduct more fluid at a lower pressure.
Also, think of the massive vasodilation in septic shock as a "relative" hypovolemia. I teach my students that it's like a 5 gallon fish tanks with 5 gallons of water. Then when septic shock hits, you put that water in a 10 gallon fishtank. You didn't lose water, but the container increased dramatically. You lose volume which is preload, which is RVP/PCWP.
Thanks for the nice video.... But I need to know why there is an increase in PCWP,JVP and decrease in BP in cardiogenic shock..??
Sudharshan vignesh the heart can't pump the blood like it should. The blood is basically backing up causing higher pressures in these readings that you mention
Thanks for the question. In cardiogenic shock the heart can't pump blood forward effectively.
Left heart failure causes an elevation in pressure in the Left Atrium which is transmitted back to the pulmonary veins and shows up on the PCWP.
Similarly, right heart failure increases the pressure in the right atrium and elevates JVP.
Decreased forward output is certainly one cause of a low blood pressure.
MedCram - Medical Lectures Explained CLEARLY Thank you very much Doc. 😊
Ok perfect that you explained all this BUT I want you to explain when a nurse contaminates a patient with MRSA, how and why? Because there suppose to be careful and change their gloves and wash their hands. No one is giving me answers. Please tell me what happens to a patient with blood clots in their lung's. With this coronavirus we need no educate ourselves also.
Thank you and God bless you all
You are My Favorite Teacher :)
Love and Respect from Pakistan !
+Saad Yousfani Thanks so much! Knowledge around the world!