cardiogenic shok some notes develops in 10% to 20% of patients hospitalized ami mortality of such...
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Cardiogenic Cardiogenic ShokShok
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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
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PathologyPathology
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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
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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
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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.
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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
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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
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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
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Definitive treatmentDefinitive treatment
Correction of hypovolemia
Treatment of arrhythmias
Treatment of hypotension
Treatment of metabolic acidosis
Treatment of electrolyte disturbances
Mechanical circulatory assist
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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**
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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
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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