Ep 164 Cardiogenic Shock Simplified

Emergency Medicine Cases

Dr. Anton Helman

Education, Health & Fitness, Courses, Medicine, Science

4.7 • 602 Ratings

🗓️ 4 January 2022

⏱️ 45 minutes

🔗️ Recording | iTunes | RSS

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Summary

What is the preferred order of vasopressors and ionotropes in the management of cardiogenic shock? In which patients would dobutamine be preferred over milrinone and vice versa? How can we best pick up occult cardiogenic shock before it floured shock kicks in? What are the best strategies to efficiently get the patient in cardiogenic shock to definitive care, whether that be the cath lab or the operating room? What is the evidence for intra-aortic balloon pumps, percutaneous ventricular assist devices and ECMO in the patient with cardiogenic shock? Which patients with acute heart are safe to send home in general? How useful is the Ottawa Heart Failure Risk Score in aiding in disposition decisions?...

Transcript

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0:00.0	Welcome to the Emergency Medicine Cases podcast.
0:05.0	I'm your host, Dr. Anton Hellman, bringing you Canada's brightest minds in emergency medicine from EMC studios in Toronto.
0:13.9	EM cases is part of SREMI, Schwartz-Risman Emergency Medicine Institute, the nonprofit organization dedicated to improving EM care through research and
0:21.3	education. The opinions expressed on this podcast are intended for information and education
0:24.2	purposes only and should not be used to diagnose treat or prevent any medical condition,
0:26.4	nor should they be used as a substitute for medical advice from qualified practicing physician.
0:30.2	In part one, with the help of doctors Tarlin Hediety and Burke Tillman, we reviewed and updated
0:35.9	some points about the diagnosis of heart failure.
0:39.1	We discussed a general approach to management, and we dove into the specifics of the acute
0:46.3	heart failure patient who is not in cardiogenic shock, including Scape.
0:52.5	In this part two, we're going to discuss the management of the very challenging patient with
0:56.8	acute heart failure and cardiogenic shock.
1:00.3	And we'll wrap it up with the sometimes difficult disposition decisions we have to make for
1:05.1	our patients with heart failure in general, basically who's safe to go home.
1:10.3	Welcome back to this part too. Thanks. Thanks for
1:12.9	having me back. It's great to be here again. All right. Let's start off with the case.
1:19.3	The same 75-year-old woman with a history of CHF and poor LV function and hypertension that we
1:25.5	discussed in part one of our two-part episode comes in a
1:28.9	month later.
1:29.9	But this time, she's been increasingly short of breath for 24 hours, and her vital
1:35.5	signs are the following.
1:37.7	Heart rate of 120, blood pressure of 95 over 60, respiratory rate of 30, oxygen saturation of 87% on a non-re breather,
	...

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