REBEL Cast REBEL Core Cast 115.0 – Cardiogenic Shock
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Dec 27, 2023 In this episode, Martin Amour, a critical care cardiologist and director of the CCU at Staten Island University Hospital, shares insights on managing cardiogenic shock. He discusses key clinical signs like cold extremities and confusion, and highlights the importance of early lactate measurement as a danger sign. Amour explains the effective use of norepinephrine as a first-line treatment and dobutiline for inotropic support. He also delves into innovative devices like impella CP and ECMO, focusing on personalized approaches for young patients and the urgency of interdepartmental collaboration.
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Defining Cardiogenic Shock
- Cardiogenic shock is defined by any cardiac disorder causing clinical and biochemical evidence of end-organ hypoperfusion.
- A patient can have cardiogenic shock even with normal or high blood pressure if there is poor perfusion.
Use Skin and Ultrasound for Diagnosis
- Assess skin temperature to differentiate cardiogenic shock (cool extremities) from septic shock (warm extremities).
- Use bedside ultrasound to detect worsening cardiac function and support diagnosis.
Use LVOT VTI to Assess Shock
- Use echocardiographic Doppler to measure left ventricular outflow tract velocity time integral (LVOT VTI).
- A VTI less than 10 cm suggests reduced stroke volume and possible cardiogenic shock.
Take Home Points: Know clinical (cold extremities, oliguria, confusion, dizziness, narrow pulse pressure) and laboratory markers (metabolic acidosis, elevated creatinine, lactic acidosis) of hypoperfusion. An elevated lactate is a danger sign and requires explanation. Norepinephrine is a great first line vasopressor in Cardiogenic shock. Dobutamine is useful for inotropic support in Cardiogenic shock. Use POCUS ...