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Cardiogenic Shock For PCCN for Progressive Care Certified Nurse (PCCN)

Cardiogenic Shock For PCCN for Progressive Care Certified Nurse (PCCN)

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Cardiogenic Shock

 

Definition/Etiology:

  • Definition
    • Circulatory failure
      • Poor Perfusion = tissue/organ ischemia = Anoxia (Cell DEATH)
      • Fluid Overload = Lung Injury → Edema
    • Numerous Types = Cardiac Focus
    • Analogy= Circulatory System = The Gas Station
      • Gas Pump = Heart
      • Hose = Vasculature
      • Gasoline = Blood/Volume
      • Vehicle = Tissues
  • Etiology/Cause
    • CAD/MI*
    • Acute Valve dysfunction
    • Heart Failure
    • Dysrhythmias
    • Pericarditis = Cardiac Tamponade

 

Pathophysiology:

  • Gas Pump Fails – Extreme version of Heart Failure
    • Decreased Cardiac Output/Perfusion
      • No Gas from Pump to vehicle
      • Gas Runs backwards
    • ↑CVP & Increased Fluid Overload
      • Fluids must go somewhere
        • Backs up to lungs = HF Sx
        • Backs up to tissues and organs
    • Compensatory
      • ↑SVR
      • Shunt blood to vital organs
      • Kidney = no perfusion =oliguria

 

Noticing: Assessment & Recognizing Cues:

  • Subjective Cues (Typical Cardiac Patient)
    • Chest Pain/SOB
    • FEEL COLD
  • Objective Cues (All point to poor perfusion)
    • Vitals
      • ↓BP (SBP<90) & Narrow Pulse Pressure
      • ↑HR (Compensation)
        • Hidden by Beta Blockers
      • Pulses ↓
      • Temp = Low
    • Hemodynamics – Art Line
      • Central Venous Pressure ↑
        • Amount of blood backing up/not getting pumped through
      • ↑ SVR (Compensation – Shunt Blood back to heart)
      • +JVD/Edema
    • Heart & Lung Sounds
      • S3/Murmurs/Muffled Heart Sounds
      • WET! Crackles/Rales
    • ↓Tissue/Organ Perfusion
      • Brain
      • Kidneys
      • Extremities

 

Interpreting: Analyzing & Planning:

  • Labs
    • H/H -hemorrhage
    • Troponin -MI
    • BNP – HF
    • BMP/CMP – Electrolytes
    • BUN/Creatinine – Arrhythmias
  • Diagnostics
    • ECG – Electricity
      • Ischemia
      • Alternans
    • Echocardiogram – Plumbing
      • Inflammation – Pericarditis
      • Valves
    • CXR – Heart Failure
      • Cardiomegaly
      • Pulmonary Edema/Effusion

 

Responding: Patient Interventions & Taking Action:

  • ABCs & Treat Cause
    • Lifesaving measures
  • Pharmacological Interventions
    • ↓SV (due to ↓ contractility and ↑ SVR)
      • + Inotropes/Dobutamine or Milrinone
        • ↑ Contractility
        • Similar outcomes but Dobutamine is faster
      • Vasopressors/Norepinephrine
        • ↑ Vasoconstriction
        • Generate pressure support
      • Anticoagulants/Thrombolytics
        • if MI/Clot
      • Diuretics -Treats HF but may ↓ BP
  • Non-Pharmacological Interventions
    • IABP – Heart Failure
    • PCI: Angioplasty, Stent- (MI/Clot)
    • Pericardiocentesis – (Tamponade)
    • Cardioversion – Dysrhythmia)
    • Open Heart (blown heart valve)
  • Adjunct Medical Therapy
    • Cardiology
    • Interventionist/Surgeon

 

Reflecting: Evaluating Patient Outcomes:

  • Airway/Breathing
    • Sufficient oxygenation is provided
    • Pulmonary congestion is decreased
  • Hemodynamics/Circulation
    • iSBP is increased to adequately perfuse tissues and vital organs.
    • BP and pulse are within normal limits for the patient.
    • Fluid and electrolyte balances are maintained
    • Intake and output are balanced

 

Linchpins (Key Points):

  • Notice
    • Objective/Subjective Cues ↓ Perfusion
  • Interpret
    • Labs/Diagnostic -underlying cause
  • Respond
    • Treating underlying cause
    • Hemodynamics
  • Reflect
    • ABCs are supported

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Transcript

References

  • AACN, and Tonja Hartjes. AACN Core Curriculum for Progressive and Critical Care Nursing. Available from: Pageburstls, (8th Edition). Elsevier Health Sciences (US),[Insert Year of Publication].
  • 4Mathew, R., Di Santo, P., Jung, R. G., Marbach, J. A., Hutson, J., Simard, T., … & Hibbert, B. (2021). Milrinone as compared with dobutamine in the treatment of cardiogenic shock. New England Journal of Medicine, 385(6), 516-525.
  • Samsky, M. D., Morrow, D. A., Proudfoot, A. G., Hochman, J. S., Thiele, H., & Rao, S. V. (2021). Cardiogenic shock after acute myocardial infarction: a review. JAMA, 326(18), 1840-1850.
  • Tehrani, B. N., Truesdell, A. G., Psotka, M. A., Rosner, C., Singh, R., Sinha, S.
    S., … & Batchelor, W. B. (2020). A standardized and comprehensive approach to the management of cardiogenic shock. Heart Failure, 8(11), 879-891.

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