Cardiogenic shock ??? have not understood well

Question 1

causes of cardiogenic shock

Answer 1

Myocardial infarction (pp796–9).
• Arrhythmias 
• Pulmonary embolus 
• Tension pneumothorax 
• Cardiac tamponade
• Myocarditis; myocardial depression
• Valve destruction (endocarditis).
• Aortic dissection

Question 2

what are the investigations that needs to be ordered ?

Answer 2

ECG, U&E, troponin, ABG, CXR, echocardiogram. If indicated, CT thorax
(speak with radiologists, this can be protocolled for both aortic dissection and PE)

Question 3

what is the management of cardiogenic shock ?

Answer 3

A-E
Oxygen
Titrate to maintain arterial saturations of 94–98%
(88–92% if COPD)

hypotensive - 500ml of crystalois over less than 15 minutes
reasses and re give up to 2L the get help

IV fluids can worsen cardiogenic pulmonary edema in most cases of cardiogenic shock. Check fluid responsiveness prior to administration of fluid therapy.
Consider a fluid challenge (250–500 mL)

If shock persists, start a vasopressor (ideally, norepinephrine).

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Diamorphine 1.25–5mg IV for pain and anxiety

Investigations and close monitoring

Correct arrhythmia, U&E abnormalities,
or acid–base disturbance

Optimize filling pressure with clinical assessment of pulse, BP, JVP/
CVP (if in ICU consider using PICCO, LIDCO, transoesophageal doppler or
Swan–Gantz catheter to estimate cardiac output and fl uid balance)

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Underfi lled?
Give a plasma expander
100mL every 15min IV
Aim MAP 70mmHg, CVP 8–10mmHg

Well/over-filled?
Inotropic support, eg dobutamine
2.5–10mcg/kg/min IVI. Aim MAP
70mmHg