Back on podcast 10, I discussed the basics of the initial approach to cardiogenic shock. Today, we bring the discussion to the next level…
Our Special Guest
Jenelle Badulak, MD
Acting Assistant Professor of Emergency Medicine, UW Medici
Dr. Badulak is an emergency physician and intensivist caring for patients in the Cardiothoracic and Medical Intensive Care Units at the University of Washington Medical Center, and in the Trauma Surgical Intensive Care Unit and Emergency Department at Harborview Medical Center.
How do we know if a patient is in cardiogenic shock and how sick they are?
How Should We Start Treatment in the ED
Characterize the Type and Severity of the Cardiogenic Shock
Evaluate for non-ventricular failure
- Is this a acute valve issue?
- Is this tamponade or another cause of obstructive shock?
Pure Left ventricular vs. Bi-ventricular/RV Failure
Decide on MCS Strategy
Cardiogenic Shock Centers
Additional Resources
- Cardiogenic shock classification Baran 2019
- Cardiogenic shock management statement 2017 AHA
- Cardiogenic Shock Centers Rab JACC 2018
Additional New Information
When to Pull the Trigger on ECMO
More on EMCrit
- EMCrit 10 – Cardiogenic Shock(Opens in a new browser tab)
- Cardiogenic shock & severe LV failure(Opens in a new browser tab)
- Approach to shock(Opens in a new browser tab)
Additional Resources
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Hello Scott, Thanks again for continuing to put out very high quality podcasts as I think this podcast really hit home many of the take home points of cardiogenic shock. I think one area that deserves more data and clarification is the use of Impella. Impella use has increased to nearly 1/3 of patients with PCI requiring MCS (1). The increase in its use has also resulted in an increase in healthcare costs. Thus it makes sense that we should really have high quality data (RCT’s) that suggest that the device is really doing what “makes physiological sense” before routinely incorporating it into… Read more »
Thanks, David. Agree on all of those points!
Hey Scott, great post as usual! Jenelle re-iterates a point I always try to teach, that MAP and perfusion can become uncoupled when you are manipulating MAP with a vasopressor, and even with an inopressor if the CO response is limited. One way I like to identify this is to use tissue saturation (brain and extremity) and see if – everything else staying equal – StO2 drops with a rise in MAP. This tells you that overvasoconstriction (SVR up CO down) is the issue, and you either need to do something about CO or tolerate lower MAP. Nope, no evidence,… Read more »
Yep! Temp is pretty easy though with some technology. I was using a surface read thermo (from cooking world)–super cheap. Then Farkas one-upped me with infared camera. Got one of those, and they are amazing, b/c get image and temp. Then can compare to prior-to-intervention. Those will run you a bit of cash.
I was looking for the Farkas post on thermal imaging in shock, would you have a link? Doing research with thermal imaging in the ICU and interested to look it up!
PS highly addicted to your podcast, thank you for creating all that amazing content
Name : Yan Li Medical ICU RN I always like taking care cariogenic shock patients