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Cardiogenic Shock, Emergency Medicine

Nadeem Alduaij Reviewed 06/2017
 


Basics

Description

  • Persistent hypotension and tissue hypoperfusion due to cardiac dysfunction in the presence of adequate intravascular volume and left ventricular (LV) filling pressure

  • Most common caus...

Diagnosis

Signs and Symptoms

  • ABCs and vital signs:

    • Patent airway (early)

    • Labored breathing and tachypnea (early); respiratory failure (late)

    • Diffuse crackles or wheezing

    • Hypoxia

    • Hypotension:

      • Systolic BP <...

Treatment

Pre-Hospital

  • ABCs, IV access, O2, monitor

  • Consider fluid bolus if no crackles

  • Aspirin

  • Nitroglycerin or morphine sulfate for chest pain in absence of hypotension

  • Transport AMI patients to facility...

Follow-Up

Disposition

Admission Criteria

All patients in cardiogenic shock require admission to a critical care unit. 

Pearls and Pitfalls

  • Cardiogenic shock is the leading cause of death in inpatient AMI.

  • Early recognition of preshock states is essential.

  • Early revascularization offers better outcomes.

Additional Reading

  • De Backer  D, Biston  P, Devriendt  J, et al. Comparison of dopamine and norepinephrine in the treatment of shock. N Engl J Med.  2010;362:779–789.

  • Peacock  WF, Weber  JE. Cardi...

Codes

ICD9

785.51 Cardiogenic shock 

ICD10

R57.0 Cardiogenic shock 

SNOMED

  • 89138009 Cardiogenic shock (disorder)

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