Cardiogenic Shock Acute pulmonary edema is a clinical condition wherein there is interstitial and alveolar edema compromising gas change in the lungs.
Usually the patient present with breathlessness of sudden onset,tachypnoea, anxiety, profuse sweating, cold clammy skin, expectoration of pink frothy sputum and cyanosis. Auscultation may reveal a gallop rhythm (S3), bilateral crepitations and rhonchi
Cardiogenic Shock Common causes
Acute myocardial infarction / ischemia
Tight mitral stenosis
Stepwise Cardiogenic Shock Management:
- make the patient sit up in bed with a back rest, preferably with the legs dangling over the sides of the bed.
- Administer 100% oxygen by nasal prongs at 5lit/minute.
- Draw blood for routine investigations.start an IV line using 5% dextrose and infuse at a very slow rate.
- Administer morphine in a dose of 3-5mg IV well diluted over several minutes .
- Naloxone may be given if respiratory depression occurs(0.4mg IV)
- Lasix 60-80 mg IV slowly
- Administer nitroglycerine 0.4-1.2mg sublingually
- Give aminophylline 5-6mg / kg diluted in 20 ml of dextrose over 20 minutes followed by 0.2-0.5mg/kg/hour in 5% dextrose as maintenance.
- if there is no response to treatment, And if the patient systolic BP is <80 mmHg or has declined by at least 30 mmHg below the previous level
- patient having signs of peripheral insufficiency like cold moist skin and cyanosis
- urine output <20ml/hour with dulled sensorium
- Use inotropic support with Dopamine 5-10 µg/kg/minute
- Dobutamine 5-10 ug/kg/minute
Call the specialist
Monitor Vital Signs
Heart rate ECG
BP Chest X – Ray and
Lung signs ABG
Septicaemic shock Management
- Resuscitation as Hypovolemic shock
- Start antibiotics
- Hydrocortisone (200mg stat to be followed by 100mg IV 6 hourly)s
- Septic focus to be dealt with.
Anaphylaxis Shock management
Anaphylaxis refers to an allergic reaction in which there are prominent dermal and systemic signs and symptoms. The full-blown syndrome includes urticaria and /or angioedema with hypotension and bronchospasm.Anaphylaxis may be mild, moderate or severe.
- Urticarial rash with pruritus,
- +/- Tachycardia, normal BP
- Above feature
- + Tachypnoea,
- +/- Bronchospasm
- Extensive urticaria,
- Perioral and periorbital angioedema,
- Severe hypotension,
- Bronchospasm +/-
- Laryngeal Edema.
Anaphylactic Shock Management
- *Make the patient lie flat on the bed
- *reassurance of the patient.
- Assured unobstructed air way
- *remove clothing and observe the extent of rash.
- *record pulse rate, respiratory rate and blood pressure
- Inj. Adrenaline 0.1 mg IM(one ampule diluted to 10ml with distilled water, and inject 1ml)
- Injection pheniramine maleate (Avil) 50mg IM (1 mg/kg)
- Injection hydrocortisone 100 mg IM (2 mg/kg)
- Make the lie flat on a bed.
- Reassurance of the patient
- Assure unobstructed air way
- Remove clothing and observe the extent of rash.
- Record pulse rate respiratory rate and blood pressure
- Inj. Adrenaline 0.25 – 0.5 mg IM
- Secure IV line using a large bore IV cannula (18 or 2 G)and infuse RL or NS rapidly 1-2 litres till blood pressure normalizes.
- Oxygen via a nasal catheter nasal prongs or venturi mask at the rate of 4-6 liters/minute.
- Inject pheniramine maleate(avil)50MG IM(1 mg/kg)
- Injection hydrocortisone 100 mg IM(2 mg /kg)
- *make the patient lie flat on the bed.
- *Assure unobstructed air way
- *Record pulse rate respiratory rate and blood pressure
- *secure IV line using a large bore IV cannula(18 or 20 G) and inject adrenaline 0.1 mg IV stat ( dilute 10 ml with distilled water, give 1 ml IV)
- *infuse RL /NS rapidly 1liter in 10 minutes
- .*monitor pulse and BP continuously and titrate IV adrenaline and IV fluids,
- Oxygen via Nasal catheter nasal prong or venturi Mask At the rate 5 ltr/Min,
- Step 2,
- Injection Pheniramine malate 50 mg / kg,
- Injection Hydrocortisone 200 mg IV Stat to be repeated according to Clinical Response,
- Injection Aminophylline 10 ml in 5 % Dextrose IV Stat Slowly if there is associated Bronchospasm,
- Monitor Vitals :-
- Blood Pressure,
- Monitor vitals Continuously Till patient recovers from Cardiogenic Shock Symptoms,