Cardiogenic shock is a state in which the organs are not receiving adequate oxygenated blood because of severe pump (heart) failure. It is an acute, sudden, extreme version of heart failure and is a medical emergency.
A myocardial infarction can cause cardiogenic shock because the heart muscle cannot pump effectively. Things that obstruct the flow of blood to the body can also cause cardiogenic shock – that includes cardiac tamponade (fluid build up around the heart that compresses it and prevents pumping) and pulmonary embolism (blood clot in the pulmonary arteries that prevent forward flow and prevent oxygenation of the blood).
The goal is to reverse the cause and restore sufficient cardiac output to the tissues. The hope would be to prevent any permanent damage from tissue ischemia and to prevent recurrence of cardiogenic shock.
Assess for Risk
Nurses should assess their patient for the risk of developing cardiogenic shock.
Either way, the more aware the nurse is of the risk, the more likely it can be prevented or caught early.
Assess and monitor:
Monitoring VS could help to prevent decompensation and cardiac arrest if caught early, but will also help to determine the patient’s response to treatment.
Level of consciousness should be assessed because it may decrease as the patient loses oxygenation of their brain. Decreasing LOC is a sign of advancing shock.
If a patient’s SpO2 falls below 92% (or prescribed threshold), apply supplemental oxygen via nasal cannula to improve overall oxygenation ability.
Assess and manage pain
Patient may have severe chest pain because of myocardial ischemia. Pain should be assessed every 4 hours or more often as needed, and reassessed 30 minutes after administration of pain medication.
Hemodynamic measurements will tell us the severity of the shock and how well the patient is responding to treatment.
Calibrate all hemodynamic monitoring transducers:
Level and Zero CVP and A-line to the phlebostatic axis
The phlebostatic axis is located at the 4th intercostal space, mid-axillary line and is the most accurate reference point for the right atrium. This is where a CVP is measured using a central line. It is also the most accurate reference point of the aorta for MAP measured by an arterial line.
Levelling and zeroing ensures that the measurements are calibrated correctly so that readings are accurate.
Prepare for procedures
Arterial lines are placed for invasive hemodynamic monitoring. They can measure MAP, but can also measure other hemodynamic values such as CO/CI, SVR, SV, etc. when using a FloTrac machine.
Central lines are placed for administration of fluids and medications as well as hemodynamic monitoring of CVP, CO/CI, and SVR. Patients with cardiogenic shock may also receive a Pulmonary Artery catheter (also called a Swan-Ganz catheter) for more detailed invasive hemodynamic monitoring.
Patients whose airway and/or ventilation has been compromised due to ↓ LOC or pulmonary edema may need to be intubated and placed on a ventilator.
Patients may need to be taken to the OR to repair the injury or internal bleeding that caused the hypovolemia in the first place.
**Informed consent MUST be obtained by the provider. You can explain procedures to patients/family, but the provider must give the reason, risks, benefits, etc. and obtain the informed consent.
Maintain HOB >30°
Lowering the head of bed or laying the patient flat can be detrimental for two reasons:
Elevate legs on pillows
SCD’s are contraindindicated if the patient already has a DVT
The goal with these interventions is to decrease peripheral edema in the patient’s legs and facilitate some venous return in order to prevent development of a DVT. DVT’s are the #1 cause of pulmonary embolism.
Prepare for and manage Intra-Aortic Balloon Pump (IABP)
This is an advanced technique that would be seen in a cardiovascular ICU. IABP is used to decrease the workload/afterload on the heart and assist with forward circulation. It is inserted via the femoral artery into the descending aorta. The balloon inflates during diastole to help with filling pressures and deflates with systole to help with forward pressure.
Advanced cardiogenic shock may require LVAD or Transplant.
Create Your Free Account