Cardiogenic Shock

Question 1

Causes:

Answer 1

1. MI
2. Arrhythmias
3. PE
4. Tension pneumothorax
5. Cardiac tamponade
6. Myocarditis
7. Myocardial depression - drugs, hypoxia, acidosis, sepsis
8. Valve destruction - endocarditis
9. Aortic dissection

Question 2

Mx Cardiogenic Shock:

Answer 2

1. Oxygen - Titrate to maintain maintain arterial saturations of 94–98% (88–92% if COPD)
2. IV access
3. Diamorphine 1.25–5mg IV for pain & anxiety
4. Bloods - ABG, U&E, troponins/cardiac enzymes
5. ECG
6. CXR/ CT thorax if indicated
7. Monitoring - BP, ABG, ECG, urine output, CVP
8. Correct arrhythmias, U&E abnormalities or acid–base disturbance
9. Optimize filling pressure with clinical assessment of pulse, BP, JVP/ CVP
10. Underfilled - Give a plasma expander 100mL every 15min IV - Aim MAP 70mmHg
11. Over filled - Inotropic support - dobutamine 2.5–10 μg/kg/min IVI - Aim MAP 70mmHg
12. Look for & Rx any reversible cause