Cardiogenic shock: Difference between revisions
| Line 54: | Line 54: | ||
*General | *General | ||
**Intubation | **Intubation | ||
***Decreases O2 demand BUT | ***Decreases O2 demand BUT may worsen preload | ||
*Coronary perfusion | *Coronary perfusion | ||
**1. Fluid challenge | **1. Fluid challenge | ||
Revision as of 21:59, 7 October 2012
Background
- Leading cause of death in pts w/ MI who reach the hospital alive
Work-Up
- Labs
- Troponin
- Lactate
- CBC
- Chem
- BNP
- <100 may rule-out cardiogenic shock
- ECG
- CXR
- TTE
Etiology
- Myocardial infarction
- Pump failure
- Mechanical complications
- Acute MR (papillary muscle rupture)
- VSD
- Free-wall rupture
- RV infarction
- Decreased forward flow
- Sepsis
- Rate-related
- Bradycardia
- Tachycardia
- Myocarditis
- Myocardial contusion
- Cardiomyopathy
- Mechanical obstruction to forward flow
- AS
- HOCM
- Mitral stenosis
- Pericardial
- LV regurgitation
- Chordal rupture
- Aortic insufficiency
DDX
- MI
- PE
- COPD exacerbation
- Peri/myocarditis
- Aortic dissection
- Pericardial tamponade
- Acute valvular insufficiency
- Sepsis
- Hemorrhage
- Toxins/drugs of abuse
Treatment
- General
- Intubation
- Decreases O2 demand BUT may worsen preload
- Intubation
- Coronary perfusion
- 1. Fluid challenge
- 2. Increase inotropy
- Titrate to CO (e.g. warm extremities)
- Dobutamine or Milrinone
- Use milrinone if pt is on BB
- CaCl 1gm
- Give if pt is hypocalcemic
- 3. Achieve MAP >65
- Pressors
- Norepi or dopamine
- Pressors
- Transfusion
- Consider if Hb < 10
- Specific
- Mitral Regurg
- Need to increase forward flow
- Dobutamine (contractility)
- Nitroprusside (afterload reduction)
- Need to increase forward flow
- MI
- PCI or thrombolysis
- Tox
- Reverse CCB, BB, or dig toxicity
- Mitral Regurg
See Also
Source
Tintinalli
EMCrit Podcast 10