Objectives • Introduction of Cardiogenic shock • Cardiovascular effects of PEEP• Management (VIP)• Mechanical ventilation
Use of PEEP
What is Cardiogenic shock?
Is a clinical condition of inadequate tissue perfusion due to cardiac dysfunction.• Myocardial infarction• End-stage cardiomyopathy• Arrhythmias• Low cardiac output
2 .A patient came to ER having
• The feel of intense chest pain and tightness• Slightly increased and unlabored RR• Oxygen saturation: 93% (on room air).• Conscious and alert • Restless and anxious
• Suspected MI
1. Chest pain2. Sweating3. Fatigue4. Dyspnea5. Edema6. On CxR : it revealed butterfly pulmonary
opacities
3 .A patient came to ER having
What is the appropriate action؟
The use of NIV for patients with ACPE is highly supported . Continuous positive airway pressure reduces mortality more in patients with ACPE secondary to acute myocardial ischemia or infarction.
Importance of Ventilation
• To protect the airway and maintain oxygen supply in patients with a deterioration in consciousness or cardiac arrest.
• To treat acute respiratory failure, most often due to cardiogenic pulmonary edema.
• To raise the arterial pH in metabolic acidosis
Infusion “Fluid Resuscitation in Shock”
• Initial fluid resuscitation• Risk of edema (CHF)• Is my patient's shock fluid responsive?• Determining Fluid Responsiveness in Shock
Type of fluid “Crystalloid” How fast to infuse it “300-500mL over 20-30 minutes” Define a positive test: ↑arterial pressure, ↓HR, ↑ urine
output Set a safety limit :↑ in CVP by 4 cm H2O “To avoid
pulmonary edema”
Pump “Use of vasoactive Drugs in Shock”
• Inotropes Adrenaline, Dobutamine
• Vasopressors Noradrenaline, Vasopressin
• Dopamine• Aspirin and Heparin• Diuretics
Use Of PEEP
Don’t have an effect
Do have an effect
↓ LV oxygen demand and improved oxygen delivery to the ischaemic myocardium
↓Venous return, LV filling, CO and overall organ perfusion
↓ Intracardiac lactate production
↑ RV afterload
• Improve hemodynamics, respiratory function and oxygenation in patients with acute systolic heart failure and pulmonary oedema compared with oxygen therapy alone.
• lower rates of intubation
• A number of reports in patients with cardiogenic shock suggest that the hemodynamic effects of PEEP may work in favor of the patient with severe left heart failure
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