Understanding Cardiogenic Shock CEN Review 2018

What is Cardiogenic Shock?

Cardiogenic Shock is defined as an inadequate tissue perfusion because of decreased cardiac output despite an adequate intravascular volume. For example, your body has adequate fluid volume but the body’s pump is failing (a.k.a the heart). THE MOST COMMON CAUSE OF CARDIOGENIC SHOCK IS MYOCARDIAL INFARCTION (SPECIFICALLY THE LEFT VENTRICULAR ANTERIOR WALL). The left anterior descending artery is in this area and is also known as widow-maker if the artery become occluded.

WHAT CAUSES CARDIOGENIC SHOCK?

  • Myocardial Infarction, Ischemia (MOST COMMON CAUSE)
  • Sustained Cardiac Dysrhythmias
  • Acute Valvular Dysfunction
  • Blunt Cardiac Trauma
  • End-Stage Cardiomyopathy

MYOCARDIAL INFARCTION MANIFESTATIONS

  • Cardiac Related Chest Pain
  • Pale, Cool, Clammy Skin
  • Tachypnea, Crackles, Pulmonary Edema
  • Tachycardia, Tachydysrhytmias
  • Altered Mental Status
  • Hypotension
  • Minimal Urine Output




 

CARDIOGENIC SHOCK ASSESSMENT

  • Start by assessing Airway, Breathing, and Circulation (ABC)
  • With any form of shock: ALWAYS DETERMINE THE CAUSE OF CARDIOGENIC SHOCK
  • Electrocardiogram
  • Chest X-Ray
  • ABG
  • Echocardiogram
  • Lab Work: CBC, Platelet Count, Liver Function Tests, Renal Function Tests, Lactate Levels

CARDIOGENIC SHOCK INTERVENTION

  • If Cardiogenic Shock is caused by pulmonary edema in the lung interstitium, Airway management with positive end-expiratory pressure (PEEP) mechanical ventilation.
  • Decrease preload by decreasing venous return to the heart
    Semi-Fowler or Fowler Position

    • Nitroglycerin
    • Diuretics
    • Morphine
  • Increase cardiac contractility
    • Dobutamine (positive inotropes)
    • Intra-aortic balloon pump (IABP)
  • Decrease afterload by decreasing the resistance the heart must pump against
    • Nitroglycerin
    • Nitroprusside
    • Antihypertensives
  • Cardiac Catheterization
  • Angioplasty
  • Treat dysrhythmias




21 thoughts on “Understanding Cardiogenic Shock CEN Review 2018”

    1. Wonderful Lyle. I am glad this information was helpful to you. Are you taking the CEN exam or just reviewing information for cardiogenic shock?

    1. Wonderful Tamela. I am glad this information was helpful to you. Are you taking the CEN exam or just reviewing information for cardiogenic shock?

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