T4 Cardiogenic Shock

• What are the classifications of shock?

  Cardiogenic, Hypovolemic, Distributive, and Obstructive.
• What is cardiogenic shock?

  Systolic or diastolic dysfunction.
• What is the most common cause of cardiogenic shock?

  Myocardial infarction.
• What are early manifestations of cardiogenic shock?

  Hypotension, tachycardia, increased SVR, increased myocardial O2 consumption.
• What can be seen on physical assessment for those in cardiogenic shock?

  Tachypnea, pulmonary congestion, pallor and cool, clammy skin, decreased capillary refill time, anxiety, confusion and agitation.
• What happens to the cardio system during cardiogenic shock?

  PAWP increases, stroke volume variation, pulmonary vascular resistance causes decreased CO and constriction, decreased renal perfusion and output.
• What study determines cardiogenic shock?

  No single study determines cardio shock.
• What diagnostics are done to evaluate for cardio shock?

  Lactate blood tests, base deficits, 12 lead ECG with continuous monitoring, chest x-ray, continuous pulse oximetry, hemodynamic monitoring.
• How can you restore blood flow to the myocardium for cardio shock?

  Angioplasty with stenting, emergency revascularization, valve replacement.
• How can you increase oxygen and ventilation for cardio shock?

  Optimize CO with fluid replacement or drugs, increase hemoglobin by transfusion, increase arterial oxygen with supplemental oxygen and mechanical ventilation.
• What is the primary goal for drugs with cardio shock?

  Correction of decreased tissue perfusion.
• What drugs are used for cardio shock?

  Vasopressors like norepinephrine to get a MAP greater than 65 mmHg and vasodilators like nitroglycerin to decrease afterload.
• When are vasopressors used with cardiogenic shock?

  For patients unresponsive to fluid resuscitation.
• What other drugs are used for cardiogenic shock and why?

  Nitrates dilate coronary arteries, diuretics reduce preload, vasodilators reduce afterload, beta blockers reduce HR.