Cardiogenic Shock - Cardiac (non-arrest)

Question 1

What are the parameters for “persistent hypotension” as per the Ornge clinical practice guideline on cardiogenic shock?

Answer 1

SBP <90 OR
MAP <60 OR
Drop of MAP 30 mmHg below baseline

Question 2

What initial fluid challenge should be administered in a cardiogenic shock patient with no signs of pulmonary congestion or respiratory distress as per the Cardiogenic Shock MDSO?

Answer 2

250 mL NS or Ringers Lactate IV/IO bolus PRN (max. 10 ml/kg)
Target MAP of >65

Question 3

What are the 2 vasoactive agents used for refractory hypotension (MAP <60) in cardiogenic shock as per the MDSO?

Answer 3

1. Norepinephrine (Levophed) target MAP >65 (initiate then patch)
2. Patch: Dobutamine (Dobutrex) min. MAP of 60 prior to initiating

Question 4

Besides the Universal Airway Algorithm what are 3 other medical directives that may be used concurrently with cardiogenic shock?

Answer 4

1. Acute Coronary Syndrome
2. STEMI
3. Cardiogenic Pulmonary Edema

Question 5

What is the MAP target in the Cardiogenic Shock MDSO?

Answer 5

MAP 60-80