Cardiogenic shock: emergency care algorithm
Cardiogenic shock is the most serious complication of myocardial infarction and other heart diseases. Timely and correct assistance to a person in a state of shock, depends on the preservation of his life. Therefore, in this article we will talk about what is cardiogenic shock, how to recognize it, and what measures should be taken to rescue the patient.
Under cardiogenic shock mean an acute heart disorder, which leads to a sharp decrease in blood pressure and deterioration of blood supply of all organs and tissues. Due to the severity and irreversibility of the pathological manifestations of this condition include critical – around 90% of patients to save and fails.
The causes and mechanisms of development of cardiogenic shock
Most often, cardiogenic shock develops as a result of extensive myocardial infarction, less – pronounced narrowing or insufficiency of the heart valves. In addition, acute heart disorder and shock can occur with pulmonary embolism, and severe arrhythmias. Children in cardiogenic shock could be a consequence of congenital heart disease. With regard to the mechanism of the development of cardiogenic shock, the main element is the increasing dysfunction of the heart muscle, which decreases cardiac output and blood circulation in the body.
Myocardial infarction can occur two options cardiogenic shock. The first reflex associated with a critical drop in blood pressure in response to severe pain, which in most cases accompanies acute coronary insufficiency. With the rapid relief of pain symptoms of shock are reduced. Therefore, all patients with signs of myocardial infarction requires analgesia, the prevention of the development of shock.
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If a patient with myocardial infarction not timely medical assistance, and necrotic changes are progressing or if the infarction is extensive, there is a sharp inhibition of the pumping function of the left ventricle and occurs in cardiogenic shock, but true. Its development is directly related to damage and dysfunction of the heart muscle.
Clinical symptoms and diagnosis
In cardiogenic shock, almost all patients show the following symptoms:
- sharp pale skin, blue lips and fingers;
- confusion or loss of it;
- sticky and cold sweat;
- shortness of breath;
- frequent but barely palpable pulse (so called filiform).
In addition, the majority of patients complain of severe chest pains – a sign of myocardial ischemia. These symptoms may be present in other diseases, and self-diagnose, and especially to give any cardiac medications the patient is impossible, an accurate diagnosis will guide the doctor. They will measure blood pressure, do an ECG and carry out other studies to determine the severity of the patient’s condition.
The appearance of the above symptoms, the patient urgently needs to be provided to qualified medical care, so the first thing to do is lay person, having parallel to it, and call doctors. During the call an ambulance, be sure to describe to the dispatcher all the details of what happened, so he sent a brigade to the patient with the necessary drugs and resuscitation equipment. The algorithm then assist the person in a state of cardiogenic shock, should be the following:
- to ensure the access of air (open a window, unbutton outer clothing, shirt, loosen tie, etc.);
- to raise a little the feet of the patient to the heart receiving more blood;
- continuously check for breathing and heartbeat and in case of their absence to initiate artificial respiration and heart massage.
In addition, emergency care in cardiogenic shock at pre-hospital stage involves the use of pain medications (for example, Baralgin and similar) if they are at hand, and they have no allergies. Pain relief allows you to pause the development of reflex hypotension, and further deterioration of the patient’s condition.
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Treatment of cardiogenic shock
Transporting patients with cardiogenic shock is possible only after stabilizing the pressure at least at the minimum allowable numbers, so the first therapeutic measures for the removal of the person from the critical state, doctors have in place. Such measures include:
- relief of pain;
- normalization of heart rate;
- strengthening the contractile function of the myocardium (this measure is particularly necessary to improve arterial pressure and restoration of blood flow);
For further treatment of patients hospitalitynet in the intensive care unit or cardiac ward, where they held round-the-clock monitoring of vital functions (breath rate and heart rate) and urine output, drug therapy, oxygen therapy, and, if necessary, connection to the apparatus of artificial life support.
In parallel with ongoing, intensive anti-shock therapy, discusses the opportunities and the most appropriate treatment for the underlying disease. In particular, myocardial infarction can be carried out a higher thrombolytic effect treatment, percutaneous balloon coronary angioplasty or coronary artery bypass grafting procedure (after initial angiography). Also of great importance in cardiogenic shock has the elimination of the consequences of shock – pulmonary edema, kidney damage, brain and liver, associated with decreased blood supply to these organs.