Cardiogenic shock

Question 1

What is cardiogenic shock?

Answer 1

A complication that may occur due to diminished myocardial contractility or as a complication of shock from any cause.

Question 2

What are some causes of diminished myocardial contractility leading to cardiogenic shock?

Answer 2

• Prolonged cardiac surgery
• Ventricular aneurysm
• Cardiac arrest
• Ventricular wall rupture

Question 3

What happens when a ventricular wall rupture occurs?

Answer 3

Blood leaks into the pericardial space, leading to cardiac tamponade and cardiovascular collapse.

Question 4

Can transient cardiogenic shock occur after resuscitation?

Answer 4

Yes, transient cardiogenic shock can occur after resuscitation.

Question 5

What condition may patients recovering from defibrillation for ventricular fibrillation exhibit?

Answer 5

Signs of cardiogenic shock.

Question 6

What conditions are often included in a patient’s history related to cardiogenic shock?

Answer 6

Cardiomyopathy, congenital heart disease, recent MI

MI stands for myocardial infarction.

Question 7

Who are the patients likely to experience cardiogenic shock after a recent MI?

Answer 7

Older adults, patients with STEMI, history of previous MI or heart failure, anterior infarction

STEMI stands for ST-Elevation Myocardial Infarction.

Question 8

When do mechanical conditions associated with a recent MI typically occur?

Answer 8

Several days to a week after the infarction

Question 9

What symptoms may indicate a dysrhythmia in patients with cardiogenic shock?

Answer 9

Palpitations, fainting, light-headedness

Question 10

What is the initial mental status of a patient in compensated cardiogenic shock?

Answer 10

Normal

Question 11

What changes in mental status occur as cerebral perfusion declines in compensated cardiogenic shock?

Answer 11

Restlessness, agitation, confusion

Question 12

What breath sounds are typically revealed in patients with cardiogenic shock?

Answer 12

Crackles

Question 13

In which patients may less evidence of pulmonary congestion be observed?

Answer 13

Patients with RVI and those who are hypovolemic

Question 14

What does JVD indicate in the context of cardiogenic shock?

Answer 14

RVF (right ventricular failure)

Question 15

What happens to JVD if the patient is hypovolemic?

Answer 15

JVD will be absent

Question 16

Describe the characteristics of the peripheral pulse in patients with cardiogenic shock.

Answer 16

Often weak and rapid; may be weak and slow if an AV block is present

Question 17

What is the typical appearance of a patient’s skin in cardiogenic shock?

Answer 17

Pale or mottled; extremities feel cool and moist

Question 18

What might the ECG show in a patient experiencing cardiogenic shock?

Answer 18

Evidence of both old and new infarctions

Question 19

How can right-sided chest leads be useful in cardiogenic shock?

Answer 19

They can detect RVI (right ventricular infarction)

Question 20

What is the initial status of SBP in patients with cardiogenic shock?

Answer 20

May be normal; pulse pressure is usually narrowed

Question 21

What additional symptoms may occur if cardiogenic shock is associated with cardiac tamponade?

Answer 21

Muffled heart sounds

Question 22

What characterizes a patient in decompensated cardiogenic shock?

Answer 22

Altered mental status or unresponsive

Question 23

What are the characteristics of breathing in decompensated cardiogenic shock?

Answer 23

Rapid and shallow; increasing pulmonary congestion and crackles

Question 24

What can happen to peripheral pulses in decompensated cardiogenic shock?

Answer 24

May be absent; central pulses are often weak and rapid

Question 25

What is the skin appearance of a patient in decompensated cardiogenic shock?

Answer 25

Pale, mottled, or cyanotic; extremities feel cold and sweaty

Question 26

What occurs to SBP as ventricular function worsens in cardiogenic shock?

Answer 26

Progressively decreases

Question 27

What is the primary focus of cardiogenic shock treatment?

Answer 27

Strengthening contractility without significantly increasing the heart rate, altering preload and afterload, and controlling dysrhythmias contributing to shock.

Question 28

What device should be applied to monitor oxygen levels in cardiogenic shock treatment?

Answer 28

Pulse oximeter.

Question 29

What position should the patient be placed in during cardiogenic shock treatment?

Answer 29

Supine position.

Question 30

If pulmonary congestion is present, what position can be used for the patient?

Answer 30

Sitting position with feet dangling.

Question 31

What should be limited in a patient with cardiogenic shock?

Answer 31

Physical activity.

Question 32

What type of monitor should be used for a patient in cardiogenic shock?

Answer 32

Cardiac monitor.

Question 33

What diagnostic test should be obtained for a patient in cardiogenic shock?

Answer 33

12-lead ECG.

Question 34

What is the goal for maintaining the patient's body temperature during treatment?

Answer 34

Maintain normal body temperature.

Question 35

What is the initial fluid treatment for suspected hypovolemic component in cardiogenic shock?

Answer 35

Trial of fluids, rapidly infuse 100 to 200 mL of normal saline.

Question 36

What should be monitored closely after fluid administration in cardiogenic shock?

Answer 36

Mental status, breath sounds, pulse, and blood pressure.

Question 37

What vasoactive IV medications are used to treat cardiogenic shock?

Answer 37

* Dopamine * Norepinephrine * Epinephrine

Question 38

What is the target minimum SBP when titrating vasoactive medications?

Answer 38

90 mm Hg or higher.

Question 39

What should be checked often during the administration of vasoactive medications?

Answer 39

IV site.

Question 40

What should be assessed to check the patient's response to treatment?

Answer 40

* Mental status * Heart rate * Respiratory effort * Breath sounds * Blood pressure

Question 41

What action should be taken if the patient does not improve after medication administration?

Answer 41

Give additional emergency care as instructed by medical direction.

Question 42

What should be done if a patient refuses care?

Answer 42

Urge the patient to accept assistance, explain worsening symptoms, and consider contacting medical direction.

Question 43

What should be documented if a patient refuses care?

Answer 43

Patient's refusal and attempts to persuade the patient to accept help.

Question 44

True or False: There are measures that can be taken in the field other than correcting a life-threatening dysrhythmia.

Answer 44

False.

Question 45

What should be completed en route to the medical facility?

Answer 45

Fibrinolytic checklist.