Cardiogenic Shok Some Notes Develops in 10% to 20% of patients hospitalized AMI Mortality of such...
-
Upload
harvey-pearson -
Category
Documents
-
view
221 -
download
1
Transcript of Cardiogenic Shok Some Notes Develops in 10% to 20% of patients hospitalized AMI Mortality of such...
Cardiogenic Cardiogenic ShokShok
Some NotesSome NotesDevelops in 10% to 20% of patients
hospitalized AMI
Mortality of such patients approximately 80% or higher
Very few patients develop shock immediately after AMI
About half of the patients develop shock within 24h
PathologyPathology
Clinical signsClinical signs
ECG shows the pattern of AMI or acute coronary insufficiency
The SBP < 80 mm Hg *
Pulse rate is 100 per min or faster**
The urinary output is low, 30 ml or less per hour
There are clinical signs of peripheral circulatory collapse
Differential diagnosisDifferential diagnosisMassive pulmonary embolism
Acute dissecting aneurism of the aorta
Acute cardiac tamponade
Acute hemorrhage
Cerebrovascular thrombosis
Diabetic acidosis
Acute pancreatitis
Acute adrenal insufficiency
Starlings law of the Starlings law of the heartheart
The ability of the heart to increase its output in response to an increase in venouse return represents a positive feedback in which altered blood flow to the heart leads to a corresponding change in blood flow leaving the heart.
Emergency treatmentEmergency treatment
The first priority in treating cardiogenic shock is to expand
the circulating blood volume with IV fluids , using the PWP or
CVP as a basic guide
Initial treatmentInitial treatment1. Position the patient*
2. Make certain that there is an adequate airway**
3. Maintain adequate oxygenation***
4. Start an IV infusion of D5W,using a regular drip bulb at a minimal flow rate
5. Insert a Swan – Ganz catheter into the PA
6. Draw blood for the tests
1. Insert a Foley catheter into the urinary bladder to obtain accurate measurements of urinary output*
2. Monitor the patient continuously**
3. Relieve pain***
4. Relieve agitation****
5. Take portable X – ray films of the chest
Initial treatmentInitial treatment
Definitive treatmentDefinitive treatment
Correction of hypovolemia
Treatment of arrhythmias
Treatment of hypotension
Treatment of metabolic acidosis
Treatment of electrolyte disturbances
Mechanical circulatory assist
Correction of Correction of hypovolemiahypovolemia
PWP less than 15 mm Hg
PWP remain stable .16 mm Hg
Initial PWP is between 15 – 18 mm Hg
PWP is 20 mmHg or higher*
Rise in PWP to 16 mm Hg or higher
PWP is low approximately 5 mm Hg
Pulmonary edema**
Schematic guideSchematic guide
Group 1Group 1 Low PWP without PE - IV fluids indicated
Group 2Group 2 Low PWP with PE - IV fluids indicated
Grout 3Grout 3 High PWP without PE - Vasodilatators, MCD
Group 4Group 4 High PWP with PE - Treatment as G3
Eugene Yevstratov Eugene Yevstratov MDMD
Phone: 0054111540682712 (ARG)Private: 0030372236344 / 0030372231698(UKr)Fax: 001 775 796 2780 (USA)Email: [email protected] / [email protected]
Link: http://myprofile.cos.com/eugenefox