Emergency Management of Cardiogenic Shock and Pulmonary Edema

Emergency Management of Cardiogenic Shock and Pulmonary Edema - Flowchart

«Flowchart»

Clinical signs: Shock, hypoperfusion, congestive heart failure, acute pulmonary edema

Most likely major underlying disturbance?

Clinical signs: Shock, hypoperfusion, congestive heart failure, acute pulmonary edema

Most likely major underlying disturbance?

Clinical signs: Shock, hypoperfusion, congestive heart failure, acute pulmonary edema

Clinical signs:

Most likely major underlying disturbance?

Acute pulmonary edema

Acute pulmonary edema Acute pulmonary edema

Hypovolemia

Hypovolemia Hypovolemia

Low output- cardiogenic shock

Low output- cardiogenic shock Low output- cardiogenic shock

Arrhythmia

Arrhythmia Arrhythmia

Clinical signs: Shock, hypoperfusion, congestive heart failure, acute pulmonary edema

Most likely major underlying disturbance?

Clinical signs: Shock, hypoperfusion, congestive heart failure, acute pulmonary edema
Most likely major underlying disturbance?

Clinical signs: Shock, hypoperfusion, congestive heart failure, acute pulmonary edema
Clinical signs:
Most likely major underlying disturbance?
Most likely major underlying disturbance?
First line of action
Administer

Furosemide IV 0.5 to 1.0 mg/kg
Morphine IV 2 to 4 mg
Oxygen/intubation as needed
Nitroglycerin SL, then 10 to 20 mcg/min IV if SBP greater than 100 mm Hg
*Norepinephrine, 0.5 to 30 mcg/min IV or Dopamine, 5 to 15 mcg/kg per minute IV if SBP <100 mm Hg and signs/symptoms of shock present
Dobutamine 2 to 20 mcg/kg per minute IV if SBP 70 to 100 mm Hg and no signs/symptoms of shock

First line of action
Administer

Furosemide IV 0.5 to 1.0 mg/kg
Morphine IV 2 to 4 mg
Oxygen/intubation as needed
Nitroglycerin SL, then 10 to 20 mcg/min IV if SBP greater than 100 mm Hg
*Norepinephrine, 0.5 to 30 mcg/min IV or Dopamine, 5 to 15 mcg/kg per minute IV if SBP <100 mm Hg and signs/symptoms of shock present
Dobutamine 2 to 20 mcg/kg per minute IV if SBP 70 to 100 mm Hg and no signs/symptoms of shock

First line of action

Administer
Administer

Furosemide IV 0.5 to 1.0 mg/kg
Morphine IV 2 to 4 mg
Oxygen/intubation as needed
Nitroglycerin SL, then 10 to 20 mcg/min IV if SBP greater than 100 mm Hg
*Norepinephrine, 0.5 to 30 mcg/min IV or Dopamine, 5 to 15 mcg/kg per minute IV if SBP <100 mm Hg and signs/symptoms of shock present
Dobutamine 2 to 20 mcg/kg per minute IV if SBP 70 to 100 mm Hg and no signs/symptoms of shock

Furosemide IV 0.5 to 1.0 mg/kg Furosemide
Morphine IV 2 to 4 mg Morphine
Oxygen/intubation as needed Oxygen
Nitroglycerin SL, then 10 to 20 mcg/min IV if SBP greater than 100 mm Hg Nitroglycerin
*Norepinephrine, 0.5 to 30 mcg/min IV or Dopamine, 5 to 15 mcg/kg per minute IV if SBP <100 mm Hg and signs/symptoms of shock present *Norepinephrine, 0.5 to 30 mcg/min IV or Dopamine, 5 to 15 mcg/kg per minute IV if SBP <100 mm Hg and signs/symptoms of shock present
Dobutamine 2 to 20 mcg/kg per minute IV if SBP 70 to 100 mm Hg and no signs/symptoms of shock Dobutamine
First line of action
Administer

Fluids
Blood transfusions
Cause-specific interventions
Consider vasopressors

First line of action
Administer

Fluids
Blood transfusions
Cause-specific interventions
Consider vasopressors

First line of action

Administer
Administer

Fluids
Blood transfusions
Cause-specific interventions

Fluids
Blood transfusions
Cause-specific interventions
Consider vasopressors
Consider
Second line of action
Check blood pressure :
Systolic BP Greater than 100 mm Hg and not less than 30 mm Hg below baseline

Second line of action
Check blood pressure :
Systolic BP Greater than 100 mm Hg and not less than 30 mm Hg below baseline

Second line of action

Check blood pressure :
Check blood pressure
Systolic BP Greater than 100 mm Hg and not less than 30 mm Hg below baseline
Systolic BP
ACE Inhibitors
Short-acting agent such as captopril (1 to 6.25 mg)

ACE Inhibitors
Short-acting agent such as captopril (1 to 6.25 mg)

ACE Inhibitors
ACE Inhibitors
Short-acting agent such as captopril (1 to 6.25 mg)

Third line of action
Further diagnostic/therapeutic considerations (should be considered in nonhypovolemic shock)
Diagnostic

Pulmonary artery catheter
Echocardiography
Angiography for MI/ischemia
Additional diagnostic studies
Therapeutic

Intra-aortic balloon pump
Reperfusion/revascularization

Third line of action
Further diagnostic/therapeutic considerations (should be considered in nonhypovolemic shock)
Diagnostic

Pulmonary artery catheter
Echocardiography
Angiography for MI/ischemia
Additional diagnostic studies
Therapeutic

Intra-aortic balloon pump
Reperfusion/revascularization

Third line of action

Further diagnostic/therapeutic considerations (should be considered in nonhypovolemic shock)

Diagnostic
Diagnostic

Pulmonary artery catheter
Echocardiography
Angiography for MI/ischemia
Additional diagnostic studies

Pulmonary artery catheter
Echocardiography
Angiography for MI/ischemia
Additional diagnostic studies
Therapeutic
Therapeutic

Intra-aortic balloon pump
Reperfusion/revascularization

Intra-aortic balloon pump
Reperfusion/revascularization
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Nitroglycerin
10 to 20 mcg/min IV

Nitroglycerin
10 to 20 mcg/min IV

Nitroglycerin
Nitroglycerin
10 to 20 mcg/min IV

See Section 7.7 in the ACC/AHA guidelines for patients with ST-elevation myocardial infarction

See Section 7.7 in the ACC/AHA guidelines for patients with ST-elevation myocardial infarction

See Section 7.7 in the ACC/AHA guidelines for patients with ST-elevation myocardial infarction

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Check blood pressure

Check blood pressure

Check blood pressure
Check blood pressure
Second line of action
Systolic BP
Greater than 100 mm Hg

Second line of action
Systolic BP

Systolic BP
Greater than 100 mm Hg
Systolic BP Greater than 100 mm Hg
Systolic BP
70 to 100 mm Hg
NO signs/symptoms of shock

Systolic BP
Systolic BP
70 to 100 mm Hg

NO signs/symptoms of shock
NO Systolic BP 70 to 100 mm Hg
Systolic BP
less than 100 mm Hg
signs/symptoms of shock^*

Systolic BP
less than 100 mm Hg
signs/symptoms of shock^*
Systolic BP
less than 100 mm Hg
signs/symptoms of shock^* ^* Systolic BP less than 100 mm Hg
*Norepinephrine 0.5 to 30 mcg/min IV or
Dopamine, 5 to 15 mcg/kg per minute IV

*Norepinephrine 0.5 to 30 mcg/min IV or
Dopamine, 5 to 15 mcg/kg per minute IV

*Norepinephrine 0.5 to 30 mcg/min IV or
*Norepinephrine 0.5 to 30 mcg/min IV or
Dopamine, 5 to 15 mcg/kg per minute IV
Dopamine, 5 to 15 mcg/kg per minute IV
Dobutamine
2 to 20 mcg/kg per minute IV

Dobutamine
2 to 20 mcg/kg per minute IV

Dobutamine
Dobutamine
2 to 20 mcg/kg per minute IV

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Bradycardia

Bradycardia
Bradycardia
Tachycardia

Tachycardia
Tachycardia
End

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End