Emergency & Critical care Medicine ******IN CARDIOGENIC SHOCK ********** Ensure adequate ventilation and oxygenation, treat emergent dysrhythmias, If the SBP is less than 70 mm Hg and the signs and symptoms of shock are present, norepinephrine is the agent of choice. If the SBP is between 70 and 100 mm Hg and the signs and symptoms of shock are present, dopamine should be used. However, if the SBP is 70 to 100 mm Hg and there are no signs or symptoms of shock, dobutamine is the agent of choice. For refractory hypotension and shock, amrinone or milrinone may improve cardiac output, although no empirical evidence is available to support their routine use. A loading dose of 0.75 mg/kg for amrinone or 50 mg/kg for milrinone is necessary, followed by a titrated constant infusion for either drug (5–10 mg/kg/min for amrinone and 0.5 mg/kg/ min for milrinone). When pharmacologic support fails to improve indices of perfusion, the next step is to initiate intra-aortic balloon pump counterpulsation (IABPC). This requires the facilities and personnel of a high- level ICU or coronary care unit (CCU). Cardiogenic shock due to MI Rx : Above measures + administer Aspirin if the patient is not allergic, and Heparin anticoagulation and arrangement for emergent Percutaneous Coronary Intervention. ** NOTE : Barbiturates are not recommended for sedation or anxiety in the intubated patient, because they may have exaggerated negative inotropic effects.
Posted on: Fri, 29 Aug 2014 09:30:33 +0000
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