All right, so we're back again. I'm here with Adam Thomas in the Internet Book of Critical

Care. And we're going to talk about cardiogenic shock and severe heart failure. This is a bohemoth

of a topic. And Josh has done an amazing job of summarizing all the important tidbits and approach for you guys.

And it's something you really need to have down tight.

Coming from a learner like myself, having a structured approach to this is very important when you're seeing patients in a merge on the ward consults, code blues, and in the unit itself.

So Josh, today we're going to cover your approach to patient evaluation and risk stratification,

and you've adapted this nice into cardiac index profusion assessment, approximating left

ventricular and diastatic pressures with pulmonary capillary wedge pressure, total body volume

status, an awesome forester classification kicking it old school from the 70s, what is old

is new again. And then we're going to move into

treatment. So you're going to treat the lungs, treat the blood pressure, optimize volume status,

look at inotropes if you need them, and then aggressively investigate and treat the underlying

problem. Last up, Josh has got a little tidbits for things to avoid and the pitfalls, of course.

So Josh, why don't you start us off?

What are we going to do with actually evaluating patients and how to risk stratify them?

There are a couple basic hemodynamic questions that you want to think about whenever you're

facing a patient with cardiogenic shock or heart failure. And in some ways, this almost generalizes

to almost any patient with shock. So the first question is, what is the cardiac index or, you know, how well profused is the patient?

Most of the time you can get a reasonable sense of that just by looking at the patient, feeling

their extremities.

Are they warm and well perfused?

Are they cool?

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