NurseSavvy Cheat SheetDisease
Cardiogenic Shock
Pathophysiology & Risk Factors
Cardiogenic shock is the failure of the heart itself as a pump. A large infarction — most often anterior — destroys enough myocardium that the left ventricle can no longer eject its contents. Cardiac output falls, so the tissues are underperfused; at the same time blood backs up behind the failing ventricle, so pulmonary pressures rise and the lungs fill. That combination of low forward flow and high filling pressure is the whole disease, and it is what makes cardiogenic shock behave in the opposite direction from every other shock a nurse manages.
Signs & Symptoms
EarlyProgresses →
cold, clammy, mottled skin Hallmark
blood is shunted away from the skin to protect the corehypotension despite adequate volume Hallmark
crackles throughout the lung fields Hallmark
the finding that separates this from hypovolemic shockjugular venous distension
blood backed up behind the failing ventricleweak, thready pulse
tachycardia
the body's attempt to compensate for the fallen outputLate / Severe
restlessness then confusion
the brain is the earliest organ to show poor perfusionfalling urine output
Interventions & Priorities
Suspected cardiogenic shock — first actions
- Oxygen and airwaythe lungs are already wet
- Withhold large bolusesmore fluid worsens the edema
- Start an inotropedobutamine strengthens the squeeze
- Add a vasopressornorepinephrine holds the pressure
- Treat the infarctrevascularization fixes the cause
Treatments & Medications
dobutamine Hallmark
inotrope — increases the force of contractionnorepinephrine Hallmark
vasopressor — constricts vessels to raise the pressurefurosemide
pulls the backed-up fluid off the lungsintra-aortic balloon pump
mechanical support when drugs are not enoughpercutaneous coronary intervention
opens the vessel that caused the infarctionReport Nowescalate immediately
urine output under 30 mL per hour Hallmark< 30 mL/hr
the kidneys are no longer being perfusednew or worsening crackles
the lungs are filling furtherfalling level of consciousness Hallmark
pressure that keeps falling on a vasopressor
pink frothy sputum
frank pulmonary edemaClinical Pearl
Cold, clammy, hypotensive AND wet lungs — the pump has failed, so do not give it more to pump.