Emergency

Management for
Cardiogenic
shock
 Cardiogenic Shock
Definition
occurs when the heart becomes
damaged
The heart is unable to pump the blood
effectively and supply to the body’s
tissues is depleted
RISK FACTORS
• Acute myocardial infarction (most common cause)
• Infectious cardiac diseases
• Myocarditis or endocarditis (inflammation or
infection of the heart)
• Certain drugs and medication (cocaine or
antidepressants, for example)
• Trauma to the heart area
• Cardiac arrhythmias (abnormal heart rhythms)
CLINICAL MANIFESTATIONS

• Hypotension Confusion/unconsciousness
• Tachycardia Pale, cool, clammy skin
• Tachypnea Decrease in urination
• Severe shortness Weak pulse
of breath Dark- colored nail beds
• ST segment changes
or premature ventricular
contraction
P P
A A
T T
H H
O O
P P
H H
Y Y
S S
I I
O O
L L
O O
G G
Y Y
 DIAGNOSTIC TEST
ECG

ST SEGMENT ELEVATION

ST SEGMENT DEPRESSION
 2.) Echocardiography

video
video
 3.) ABG Analysis
for signs of hypoxemia and acidosis
 MEDICAL MANAGEMENT

The goals of medical management in

cardiogenic shock is :
• to restore blood flow,
• limit the myocardial damage,
• preserve the healthy myocardium
• to improve cardiac function.
 First line of Treatment

• Oxygenation- for initial management as

well as supplementation
• Morphine/Demerol- for pain
• IV Fluid Therapy
• Intraaortic balloon pump
• Left Ventricular Assist Device
 Intraaortic Balloon Pump
vi
d
e
o
Left Ventricular Assist Device

Left Ventricular Assist Device

 Pharmacologic Intervention
• Dopamine- increases renal perfusion and
increase in CO
• Nitroglycerine- decreases venous resistance
and coronary artery dilation
• Norephinephrine(levophed)- peripheral
vasoconstrictor; used in patients with
low systolic pressure (<70mmHg) to
prevent total circulatory collapse.
Milrinone(Primacor)- for vasodilation,
reduces preload and afterload while
increasing the pumping of the heart

Dobutamine- increases pumping action of the

heart.
 NURSING MANAGEMENT
• Provide oxygen as ordered.
• If the patient develops respiratory
distress, be prepared for intubation
and mechanical ventilation.
• Administer low-dose morphine
sulfate
• Maintaining bed rest and decreasing
anxiety, fever, and pain.
• Position the patient for maximum lung
expansion and comfort.
• Administer diuretics and /or vasodilators as
ordered to reduce circulating volume and
decrease preload.
 Prepared by:
Norbert June T. Mangalonzo
BSN IV-4

Submitted to:
Prof. Juanito Mandia, RN