Cardiogenic Shock: Clinical Manifestations, Special Needs, and Intermediate Actions
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This article discusses the clinical manifestations, special needs, and intermediate actions for cardiogenic shock. It also explains the types of shock and the differences in special needs for each type.
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Running head: CARDIOGENIC SHOCK Name of the Student Name of the University Author Note
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1 CARDIOGENIC SHOCK Question 1: The case study represents emergency of myocardial infarction of a 57-year-old man who has been brought in to the emergency department by ambulance, complaining of intense retrosternal chest pain. In the current on the situation, on assessment it was found that patient disorientated, regular heart rate (90 bpm), pain (8/10), diaphoretic and clammy, BP 68/49 on the non-invasive monitor, respiratory rate is 32 (bpm) with an oxygen saturation of 91%. In the current context, the low blood pressure, diaphoresis and respiratory rate because of low O2 are three clinical manifestations. •He was diaphoretic and clammy which is a condition in a patient when the sympathetic nervous system of patient activates the sweating glands through a chemical messenger called acetylcholine. Diaphoresis is excessive sweating because of health conditions (Thiele et al., 2018). Although he had regular heart rate (90), he had myocardia infection where he was experiencing cardiogenic shock. Because of shock peripheral circulation of the body decreased which manifested as sweating. In sweating, the sweat gland secrets to adrenergic stimulation and release of catecholamine and congeneric agents and patient experience cold feet (CocciaI et al., 2018). •His oxygen level is low (91%) because of myocardial infarction. The oxygen level is low because reduced contractility as a result of the release of catecholamine (Harjola et al., 2018). Identifying a lack of oxygen in the blood which further exhibited as high respiratory rate since the heart is hyperventilated to pump the blood (Myslinski, Heiser & Kinney, 2018).
2 CARDIOGENIC SHOCK •As the heart is not pumping an adequate amount of blood as a result of low contractility which further reduced the cardiac output (Thieleet al., 2018). Cardiac output is called the amount of blood pumped by blood per minute as per the demand of the tissues of the body (Amaral et al., 2017).When the body demands a high level of metabolically controlled flow, tissue demands high blood flow. In the current context, because of low contractility of blood, the cardiac out reduced which in turn reduces the blood pressure ( 68/49) (Basir et al., 2017).The reduced blood pressure also reduces the oxygen level followed by damaged occurred in the cardiac muscles due to lack of oxygen supply to the blood (Myslinski, Heiser & Kinney, 2018). Hence, in order to manage the health condition of patient it is crucial to manage these clinical manifestations and identify special need of the patient for faster recovery of the patient. Question 2: There are several types of shock which can be observed in the health issues. Considering the health condition of MR. Beckett, cardiogenic shock is the shock he was experiencing (Gokhroo et al., 2017). Cardiogenic shock is defined as a shock body experience as a result of sudden damage to the cardiac muscles due to the inability of the heart to pump an adequate amount of oxygenated blood. This damage further disrupts the functionality of the main chamber which is left ventricle (VEN-trip-Ku). Although cardiogenic shock is most common for ischemic heart disease such as myocardial infraction where plaque deposited in the coronary arteries and narrowed down the artery and reduces the blood flow followed by clotting of blood. Cardiogenic shock can be observed in patients with a health condition such as myocarditis, endocarditis, life threating arrhythmias and Pericardial tamponed (Myslinski, Heiser & Kinney, 2018). As a result, patients experience symptoms such as sweating, cool hands, and feet, rapid breathing which is evident in this case study. In the current context, the goal of managing the health condition of the patient is to improve the blood flow of the patient and oxygen level
3 CARDIOGENIC SHOCK (Thieleet al., 2018).To improve the oxygenation a ventilator would be help which would be effective to protect the airway as well as to provide extra oxygen. Providing patient with medications which prevent blood clotting such as blood thinner and providing the patient with vasodilator to improve the blood flow are two special need (Backhaus et al., 2017). Another kind of medical shock is a septic shock which is the potential fatal medical condition when organ damage has occurred in response to the medication which further reduces the blood pressure and induces the abnormality in cellular metabolism (Gokhroo et al., 2017). However, a special need for a patient with septic shock slightly different for the patient who is experiencing septic shock. While the prime goal of health professionals to treat cardiogenic shock is to improve oxygenation and improve blood flow through vasodilator and ventilation, the patient with septic shock requires antibiotic first to fight with the infection followed by the large amount of intravenous liquid to recover from the blood loss (Gokhroo et al., 2017).The intravenous fluid with the help of the central venous catheter is a better option in order to restore the blood (Singer et al., 2016). This treatment is not recommended for a cardiogenic shock since the heart can’t pump the blood. Hence, the special needs of patients with two different type of shock differ. Question 3: The intermediate actions that follow after the cardiogenic shock are as follows •Oxygenation level is required to improve for the patients. In this case, the patient is experiencingshortnessofbreath,soextraoxygenisprovidedbyconnectingthemwith ventilators. A ventilator is a machine which supports the breathing since it protects the airway and provides the patient with extra oxygen by exchanging air between the lungs and atmosphere in exchange of carbon dioxide (Hongisto et al., 2016). This will improve the oxygen level of the
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4 CARDIOGENIC SHOCK patient and reduce the effect of the cardiogenic shock which the patient experienced because of the low level of oxygen in the cardiac muscles as well as tissues. It will improve the oxygen situation to 98 %, improve the cardiac output and increase the blood pressure to 10/80 which is the normal range (Myslinski, Heiser & Kinney, 2018). •Dopamine and dobutamine are the vasodilators which improve cardiac contractility. An administration of dopamine is crucial for the patient with hypotension since vasodilators works on the vascular smooth muscles which further improve forward flow that in turn improve cardiac out (Richards et al., 2015). Hence it would be effective for the patient since the patient had low cardiac out which caused the low blood pressure (Richards et al., 2015). The administration of the medication improves the blood flow and reduces the risk of injury of other organs. •In order to prevent blood clotting of the patient, blood thinner or thrombolytic medications would be effective for the patient. In the current context, since he experiences myocardial infarction where the health professionals suggested he would require cardiac angiogram, the thrombolytic drug is crucial for preventing blood clot (Richards et al., 2015). The patient can be administrated with heparin which markedly attenuates the thrombin activity associated with thrombolysis. Inpatient, the heparin dissolves dangerous clots present in blood vessels which dissolve the blood clot in the blood vessels which in turn improve the blood flow and damage to the tissues and other associated organs (Myslinski, Heiser & Kinney, 2018).. After taking these three options, health professionals are required to conduct a medical surgery such as cardiac angiogram which use a balloon to dissolve the blood clot and condition of the patient. References:
5 CARDIOGENIC SHOCK Amaral, L. M., Wallace, K., Owens, M., & LaMarca, B. (2017). Pathophysiology and Current ClinicalManagementofPreeclampsia.CurrentHypertensionReports. doi:10.1007/s11906-017-0757-7 Backhaus, T., Fach, A., Fiehn, E., Schmucker, J., Garstka, D., Stehmeier, J., ... & Hambrecht, R. H.(2017).P4639TherapyandoutcomeofconsecutivepatientswithST-segment elevation myocardial infarction and cardiogenic shock-Do patients profit from immediate multivesselPCI?.EuropeanHeartJournal,38(suppl_1). https://link.springer.com/article/10.1007/s00134-016-4223-9 Basir, M. B., Schreiber, T. L., Grines, C. L., Dixon, S. R., Moses, J. W., Maini, B. S., ... & O'Neill, W. W. (2017). Effect of early initiation of mechanical circulatory support on survivalincardiogenicshock.TheAmericanjournalofcardiology,119(6),845- 851.https://doi.org/10.1016/j.amjcard.2016.11.037 CocciaI, C. B., PalkowskiI, G. H., SchweitzerII, B., MotsohiII, T., & Ntusi, N. A. (2016). Dyspnoea: Pathophysiology and a Clinical Approach.SAMJ: South African Medical Journal, pp. 32-36. doi:10.7196/SAMJ.2016.V106I1.10324 Gokhroo, R. K., Ranwa, B. L., Kishor, K., Priti, K., Ananthraj, A., Gupta, S., & Bisht, D. (2016). Sweating: A Specific Predictor of ST-Segment Elevation Myocardial Infarction Among theSymptomsofAcuteCoronarySyndrome:SweatingInMyocardialInfarction (SWIMI) Study Group.Clinical Cardiology, pp. 90-95. doi:10.1002/clc.22498
6 CARDIOGENIC SHOCK Harjola, V. P., Lassus, J., Sionis, A., Køber, L., Tarvasmäki, T., Spinar, J., ... & Di Somma, S. (2015). Clinicalpictureandriskpredictionof short‐termmortalityincardiogenic shock.Europeanjournalofheartfailure,17(5),501-509. https://onlinelibrary.wiley.com/doi/full/10.1002/ejhf.260 Hongisto, M., Lassus, J., Tarvasmaki, T., Sionis, A., Tolppanen, H., Lindholm, M. G., ... & Carubelli,V.(2017).Useofnoninvasiveandinvasivemechanicalventilationin cardiogenicshock:aprospectivemulticenterstudy.Internationaljournalof cardiology,230,191-197. https://helda.helsinki.fi/bitstream/handle/10138/234775/1_s2.0_S0167527316348264_ma in.pdf?sequence=1 Myslinski, J., Heiser, A., & Kinney, A. (2018). Hypovolemic Shock Caused by Angiotensin- Converting Enzyme Inhibitor-Induced Visceral Angioedema: A Case Series and A Simple Method to Diagnose this Complication in the Emergency Department.The Journalofemergencymedicine,54(3),375-379. https://www.researchgate.net/profile/Ashish_Jain52/publication/328567156_Hypovolemi c_shock_-_A_review/links/5c5d9fb9a6fdccb608b0b7a4/Hypovolemic-shock-A- review.pdf Richards, J. C., Racine, M. L., Hearon, C. M., Kunkel, M., Luckasen, G. J., Larson, D. G., ... & Dinenno, F. A. (2018). Acute ingestion of dietary nitrate increases muscle blood flow via local vasodilation during handgrip exercise in young adults.Physiological reports,6(2). https://physoc.onlinelibrary.wiley.com/doi/pdf/10.14814/phy2.13572 Singer, M., Deutschman, C. S., Seymour, C. W., Shankar-Hari, M., Annane, D., Bauer, M., ... & Hotchkiss, R. S. (2016). The third international consensus definitions for sepsis and
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7 CARDIOGENIC SHOCK septicshock(Sepsis-3).Jama,315(8),801-810.Retrievedfrom: https://jamanetwork.com/journals/jama/fullarticle/2492881?ncid=txtlnkusaolp00000618 Thiele, H., Ohman, E. M., Desch, S., Eitel, I., & de Waha, S. (2015). Management of cardiogenic shock.Europeanheartjournal,36(20),1223-1230. https://academic.oup.com/eurheartj/article/36/20/1223/2293258