Emergency Management of Cardiogenic Shock and Pulmonary Edema - Flowchart
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?

Most likely major underlying disturbance?

Acute pulmonary edema

Acute pulmonary edema

Acute pulmonary edema Acute pulmonary edema

Hypovolemia

Hypovolemia

Hypovolemia Hypovolemia

Low output-cardiogenic shock

Low output-cardiogenic shock

Low output-cardiogenic shock Low output-cardiogenic shock

Arrhythmia

Arrhythmia

Arrhythmia Arrhythmia

First line of action

Administer


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

First line of action

Administer


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

First line of action

Administer

Administer


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


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

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

Systolic bp
Greater than 100 mmHg and not less than 30 mmHg below baseline

Second line of action

Systolic bp
Greater than 100 mmHg and not less than 30 mmHg below baseline

Second line of action

Systolic bp
Greater than 100 mmHg and not less than 30 mmHg below baseline

Systolic bp

Second line of action

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

Second line of action

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

Second line of action

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

ACE Inhibitors

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


Mechanical circulatory support
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


Mechanical circulatory support
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


Mechanical circulatory support
Reperfusion/revascularization


Mechanical circulatory support
Reperfusion/revascularization

End

End

End

End

End

End

Second line of action

Nitroglycerin
10-20 mcg/min IV

Second line of action

Nitroglycerin
10-20 mcg/min IV

Second line of action

Nitroglycerin
10-20 mcg/min IV

Nitroglycerin

First line of action

See Section 9.5 in the ACC/AHA 2013 guidelines for pts with ST-elevation myocardial infarction

First line of action

See Section 9.5 in the ACC/AHA 2013 guidelines for pts with ST-elevation myocardial infarction

First line of action

See Section 9.5 in the ACC/AHA 2013 guidelines for pts with ST-elevation myocardial infarction

End

End

End

Second line of action

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

Second line of action

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

Second line of action

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

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

Second line of action

Dobutamine
2-20 mcg/kg per minute IV

Second line of action

Dobutamine
2-20 mcg/kg per minute IV

Second line of action

Dobutamine
2-20 mcg/kg per minute IV

Dobutamine

End

End

End

End

End

End

End

End

End

First line of action

Bradycardia

First line of action

Bradycardia

Bradycardia

First line of action

Tachycardia

First line of action

Tachycardia

Tachycardia

Second line of action

Check blood pressure

Second line of action

Check blood pressure

Second line of action

Check blood pressure

Check blood pressure

First line of action

Check blood pressure

First line of action

Check blood pressure

First line of action

Check blood pressure

Check blood pressure

Second line of action

Systolic bp
Greater than 100 mm Hg

Second line of action

Systolic bp
Greater than 100 mm Hg

Systolic bp
Systolic bp Greater than 100 mm Hg

Second line of action

Systolic bp
70 to 100 mm Hg
NO signs/symptoms of shock

Second line of action

Systolic bp
70 to 100 mm Hg
NO signs/symptoms of shock

Systolic bp

NO Systolic bp 70 to 100 mm Hg

Second line of action

Systolic bp
less than 100 mm Hg
signs/symptoms of shock* 

Second line of action

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