CARDIOGENIC  SHOCK
Etiology:

  1. CAD/MI is the most common cause with at least 40%  LV damage.
     
  2. Myocardial trauma/Tamponade
     
  3. Myocarditis
     
  4. Acute Valvular Disease

S & S:

  1. ¯BP, signs of hypopefusion such as cyanosis, ¯UO, cool and diaphoretic skin, altered sensorium.

DX:

  1. Swan-Ganz = ­PCWP/¯CO/­SVR. Normal values are: 6-12mmHg / 3.5-5.5L / 800-1200 dyne respectively.
     
  2. ECHO
     
  3. ­in lactic acid.

Treatment:

  1. O2
     
  2. IVF boluses of 200mlx2
     
  3. Vasopressors:
    1. Dopamine 5-15mcg/kg/min
       
    2. Dobutamine 2-15mcg/kg/min
       
    3. Norepinephrine (Levophed) 15mcg/min titrate to SBP of 90mmHg. DC as soon as SBP of  90mmHg is obtained since it  increases Oxygen demand and SVR.
    4. IABP if above fail.
       

 

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