Shock (Cardiogenic)
DEFINITION
Refer Shock.
This card focuses on specific management points of cardiogenic shock.
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MANAGEMENT
General Pointers
Treat cause
Fluids make situation worse.
A mortality benefit using thrombolytics for pts with cardiogenic shock
after
MI has not been demonstrated.
Therapeutic
Cardiac Function
Control HR
Treat any arrythmia.
High-flow O2.
IV adrenergics
If severe heart failiure on the basis of diminished myocardial fx.
Require ECG monitoring for arrhythmias.
Ideally in CCU/DCCM - follow protocols.
Dobutamine causes little tachycardia, so useful to minimise excessive
myocardial O2 consumption.
BP
If BP falls remains below 80 systolic on dobutamine, a
vasoconstrictor such as dopamine or adrenaline should be considered.
Preload Reduction
(Preload is usually inappropriately elevated)
Stop fluids.
Nitrates, diuretics, morphine.
Afterload Reduction
(Often inappropriately elevated)
If BP satisfactory, use vasodilators.
ACEi are tx of choice and usually begun when pt stable (contraindicated
if AS or bilateral renal artery stenosis).
Initial dose, then maintenance according to renal fx and clinical
status - start low, titrate up to highest possible.
Watch for hypotension, renal impairment and hyperkalaemia.
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