CARDIOGENIC SHOCK Signs and Symptoms: What is Cardiogenic Shock?

Cardiogenic shock is the inability to meet the metabolic needs due to severely impaired contractility of either ventricle. That leads to decreased tissue perfusion and a shock like state. Risk factor includes prior myocardial infarction, advanced age Cardiogenic shock may be prevented with early revascularization in patients with myocardial infarction (MI) and with required intervention in patients with structural heart disease. A lack of oxygen-rich blood reaching the brain, kidneys, skin, and other parts of the body causes the signs and symptoms of cardiogenic shock. Pale, cool and clammy skin Cool hands and feet Pulmonary congestion and hypoxemia worsen as the ventricles fail to eject adequate volume and the blood backs up into the lung. Tissue hypoperfusion continues because the oxygen does not meet the metabolic needs. Confusion or lack of alertness Loss of consciousness A sudden and ongoing rapid heartbeat A weak pulse Rapid breathing Decreased or no urine output

Pathophysiology of Cardiogenic Shock:

Medical Management
"The key to a good outcome in patients with cardiogenic shock is an organized approach, with rapid diagnosis and prompt initiation of pharmacologic therapy to maintain blood pressure and cardiac output." Cardiogenic shock is an emergency requiring immediate resuscitative therapy before shock irreversibly damages vital organs. 1. All patients require admission to an intensive care setting, which may involve emergent transfer to the cardiac catheterization suite, critical care transport to a tertiary care center, or internal transfer to the intensive care unit (ICU). Early and definitive restoration of coronary blood flow is the most important intervention for achieving an improved survival rate. At present, it represents standard therapy for patients with cardiogenic shock due to myocardial ischemia. Correction of electrolyte and acid-base abnormalities, such as hypokalemia, hypomagnesemia, and acidosis, is essential in cardiogenic shock.

A Vicious Cycle: Compensatory responses initially stabilize the patient but later cause the patient to deteriorate as O2 demands of the already compromised heart rise. These events comprise a vicious cycle of low CO, Sympathetic compensation, Myocardial ischemia and even lower CO.

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Medical Interventions:
1. Make sure the airway is adequate, if not conscious, intubation should be performed. 2. Give oxygen 8-15 liters / minute by using a mask to maintain pO 2 70-120 mm Hg 3. Pain due to acute infarction, which can increase the shock that there must be overcome by administering morphine. 4. Correction of hypoxia, electrolyte disturbances and acidbase balance that occur. 5. If possible pairs of CVP. 6. Swan Ganz catheterization for hemodynamic research.

Nursing Interventions: Diagnostic

Patient Monitoring o Obtain HR, RR, and BP every 15 minutes to evaluate the patients response to therapy and detect cardiopulmonary deterioration. o Assess the patients respiratory status. The use of accessory muscles and inability to speak suggest worsening pulmonary congestion. o Assess for excess fluid volume, which can further compromise myocardial function. Diagnostic Assessment o Review ABGs for decreasing trend in Pao2 (hypoxemia) or pH (acidosis). These conditions can adversely affect myocardial contractility. o Review serial chest radiographs to evaluate the patients progress or a worsening lung condition. Continuously monitor oxygenation status with pulse oximetry. Monitor for desaturation in response to nursing intervention. Monitor ECG for dysrhythmias caused by hypoxemia, electrolyte imbalances, or ventricular dysfunction. Monitor fluid volume status.

Therapeutic
Provide supplemental oxygen as ordered. If the patient develops respiratory distress, be prepared for intubation and mechanical ventilation. Administer low-dose morphine sulfate as ordered to reduce preload in an attempt to decrease pulmonary congestion. Minimize oxygen demand by maintaining bed rest and decreasing anxiety, fever, and pain. Position the patient for maximum chest excursion and comfort. Administer diuretics and /or vasodilators as ordered to reduce circulating volume and decrease preload.