Cardiogenic Shock
DEFINITION OF CARDIOGENIC SHOCK:
Cardiogenic
shock is a condition in which the heart suddenly can’t pump enough blood to
meet the body’s needs. The condition is most often caused by a severe heart
attack. Cardiogenic shock is rare, but it’s often fatal if not treated
immediately.
CAUSES OF CARDIOGENIC SHOCK:
A. Acute MI:
1.
Pump failure
2.
Right ventricular infraction
3.
Mechanical complications.
B.
Other condition:
1.
End-stage cardiomyopathy
2.
Myocardial contusion
3.
Prolonged
cardiopulmonary bypass
4.
Septic
shock with myocardial depression.
5.
Vulvular
disease.
SIGNS
AND SYMPTOMS OF CARDIOGENIC
SHOCK:
1.
Rapid breathing
2.
Severe
shortness of breathing
3.
Tachycardia
4.
Loss of
consciousness
5.
Weak pulse
6.
Low blood pressure
7.
Sweating
8.
Pale skin.
INVESTIGATION
OF CARDIOGENIC
SHOCK:
1.
Physical examination
2.
ECG
3.
CXR
4.
Echocardiography
5.
Cardiac biomaker
6.
Pulmonary artery catheterization: swan-Ganz
catheter.
RISK
FACTOR OF CARDIOGENIC
SHOCK:
1.
Extensive damage to left myocardium
2.
Age>70 years
3.
SBP<120mmHg
4.
Sinus tachycardia rate>110/min
5.
Bradycadia rate<60/min
6.
Increased time from onset of STEMI
7.
H/O Hypertension, diabetes mellitus
8.
Prior MI
or angina
9.
Left bundle branch block
TREATMENT
OF CARDIOGENIC
SHOCK:
Fluids
and plasma given through an IV and medications to treat cardiogenic shock, work
to increase your heart’s pumping ability. Intropic agents. You might be given
mediations to improve your heart function, Such as nor epinephrine (levophed)
or dopamine, until other treatments starts to work, Aspirin.
NURSING MANAGEMENT OF CARDIOGENIC SHOCK:
A) Initial
management:
a) Administer oxygen by face mask or
artificial airway to ensure adequate oxygenation of tissues.
b) Adjust the oxygen flow rate to higher
or lower level,as blood gas measurements indicate.
c) Assess vital sign strictly
d) Assess functioning of ECG monitoring
and reading.
B) Administering medications and IV fluids:
a) Administer an osmotic
diuretic, such as manitol,if ordered to increases renal blood flow and urine
output.
· Medications
in choice:
Ø Dobutamine.
Ø Nitroglyserine.
Ø Dopamine.
· Vasoactive
medications:
Ø Epinephrine
Ø Nor-epinephrine
Ø Vasopressin
b) Monitor vital -sign before
and after administering medications and IV fluids
c) Asses IV infusion site for
bleeding or any allergic reaction
d) Monitor –Urine output Serum
creatinine.
C) Strict monitoring:
a) Monitor
and record blood pressure, pulse, respiratory rate and peripheral pulse every 1
to 5 minutes until the patient stabilize.
b) Record
hemodynamic pressure readings every 15 minutes.
c) Monitor
complete blood count and electrolyte level
d) During
therapy assess skin color and temperature and any change.
D) Limit myocardial oxygen demand by:
a) Administer
analgesics, sedatives and other agents as prescribed.
b) Positioning
the patient as comfort.
c)
Limiting activities.
d) Providing
calm and quiet environment.
E) Emotional support and health
maintenance:
a) To
ease emotional stress, allow frequent rest periods as poss
b) Offering
support to reduced anxiety
c) Teaching
the patient about his condition
d) Allow
family members to visit and comfort the patient as much as possible.
COMPLICATION
OF CARDIOGENIC
SHOCK:
1.
Brain damage
2.
Kidney
damage
3.
Liver
damage
4.
Multiple organ failure
5.
Coma
6.
Death.
PREVENTION
OF CARDIOGENIC
SHOCK:
1. 1. Primary:
a) Teach
patients the point of diet and exercise to minimize the risk factors.
2. Secondary:
a)
Provide oxygen.
b) Administer
inotropics and vasodilator.
3. Tertiary :
a)
Provide intra-aortic ballon pump.
b) Administer
inotropics and vasodilator.
 |
| Cardiogenic shock |
0 Comments