…corresponds to an acute increase in the SOFA score of at least 2 points. Septic shock is the subgroup that, despite the treatment of hypovolaemia…

Critical care Myocardial ischemia and infarction Definition and Pathophysiology Cardiogenic shock is a state of inadequate tissue and end organ perfusion caused by cardiac insufficiency…

Arrhythmias and arrhythmology Procedurer Lathundar Electrical cardioversion is the delivery of a precisely regulated electrical shock to terminate a tachyarrhythmia, and it encompasses both synchronized…

…wave to synchronise to; sync mode would block the shock entirely The patient Awake or sedated — requires sedation Unconscious In polymorphic VT, sync must be…

Cardiology Critical care Pharmacology & dosing Definition and Pathophysiology In the management of acute heart failure and cardiogenic shock, intravenous vasoactive agents are categorised according to…

…Skin symptoms may be absent, and circulatory shock does not have to be present for the condition to be serious [1]. Intramuscular adrenaline (epinephrine) is…

…mmHg for 15 minutes, or a need for a vasopressor), obstructive shock or cardiac arrest with suspected pulmonary embolism. Urgent bedside echocardiography, looking for right…

…LAD) and left circumflex (LCx) arteries (Figure 1). Acute obstruction can lead to rapid hemodynamic deterioration, cardiogenic shock, malignant ventricular arrhythmias, or sudden cardiac death…

…and should be managed urgently. The risk of cardiogenic shock and cardiac arrest is high and pharmacological interventions are frequently futile. It is often necessary…

…5 . Ventricular fibrillation (VF). ECG 6 . Delivery of shock, followed by asystole. ECG 7 . Asystole after shock. ECG 8 . Recurrence of supraventricular rhythm. ECG 9…

…fibrillation (VF). ECG 4 . Polymorphic VT progresses to ventricular fibrillation (VF). ECG 5 . Ventricular fibrillation (VF). ECG 6 . Delivery of shock during ventricular fibrillation (VF).

…normally 950–1150 mL/min Haemodynamic profiles in shock Type CO SVR CVP/PCWP ScvO₂ : : : : : : : : : Hypovolaemic ↓ ↑ ↓ ↓ Cardiogenic ↓ ↑ ↑ ↓…

…and patients with advanced renal failure, marked heart failure or circulatory shock require a specific protocol and early specialist involvement. DKA and HHS are dynamic…

…shock Haemoglobin, transfusion threshold 70 g/L 80 g/L in acute coronary syndrome See the circulatory and haemodynamic parameters for pressures, flows and shock…

…50 × the upper limit of normal: paracetamol poisoning, ischaemic hepatitis ("shock liver") or acute viral hepatitis. The three are distinguished by the history and the…

…antibiotics are associated with a worse outcome in sepsis and in several studies of neutropenic patients. In septic shock, or where sepsis is highly likely…

…unstable patient should be cardioverted, not investigated. Contraindications Haemodynamic instability — hypotension, shock, impaired consciousness or pulmonary oedema. Treat the arrhythmia first. Known stricture or tumour…

…range, or a PaO2 below 8 kPa on an arterial blood gas. Acute critical illness during initial stabilisation — cardiac arrest, shock, sepsis, major trauma, unconsciousness…

…inflow The echocardiographic counterpart of pulsus paradoxus Contraindications In overt tamponade with shock there are no absolute contraindications other than the conditions in which the…

…patient at risk of rapid deterioration. Intraosseous access: Cardiac arrest where venous access is not immediately available. Shock, severe trauma, burns or status epilepticus when…

…that pacing hurts a great deal in a conscious patient. Indications Immediate (transcutaneous) pacing in bradycardia with haemodynamic compromise — hypotension, shock, impaired consciousness, heart failure…

…the work of breathing, the peripheral perfusion and the signs of shock 2 Two large bore peripheral cannulae. Consider an arterial line if the patient…

…Dobutamine Cardiogenic shock Bradycardia (second line therapy) Stress testing (due to induced increase in myocardial O 2 consumption) Regular : 2.0–20 μg/kg…

…MAP within an optimal range is crucial in managing conditions like sepsis, trauma, and shock, where perfusion may be compromised. Hemodynamic determinants of MAP Hemodynamically…

…cardiac arrest, electrical or haemodynamic instability, and cardiogenic shock. ACS is distinct from myocardial infarction (MI). MI denotes cardiomyocyte necrosis occurring in the clinical setting…

…no imaging evidence of RV dysfunction. Catastrophic or “supermassive” PE refers to refractory cardiogenic shock or the need for ongoing cardiopulmonary resuscitation. Mechanical circulatory support…

…formation is associated with poor short term prognosis, although early mortality is usually related to the extent of myocardial injury and its complications—shock, reinfarction…

…failure presumed to result from ongoing myocardial ischaemia Haemodynamic instability or cardiogenic shock Life threatening arrhythmias or cardiac arrest after presentation Mechanical complications of myocardial…

…right ventricle is rare. The clinical spectrum extends from limited right ventricular dysfunction to severe right sided failure and cardiogenic shock. The haemodynamic disturbance results…

…risk is high, the diagnosis is uncertain, cardiogenic shock is present, or symptoms have been present for more than 2–3 hours. Patients with a…

…Mechanical or pump failure complications , including heart failure and cardiogenic shock. Most out of hospital deaths occur early and are commonly related to ventricular fibrillation…

…bradyarrhythmia, respiratory failure with severe hypoxaemia, severe anaemia, and hypotension or shock. Conversely, mechanisms that increase myocardial oxygen demand include sustained tachyarrhythmia and severe hypertension…

…edema develops due to rising LAP and LVEDP. Cardiogenic shock develops if the cardiac output is insufficient. Aortic regurgitation may cause myocardial ischemia because cardiac…

…usually unaffected, but the shock volume and ejection fraction (EF) may be reduced because the end diastolic volume of the ventricle (EDV) is reduced. Constrictive…

…Dobutamine Cardiogenic shock Bradycardia (second line therapy) Stress testing (due to induced increase in myocardial O 2 consumption) Regular : 2.0–20 μg/kg…

…condition and should be managed urgently. The risk of cardiogenic shock is high and pharmacological interventions are often futile. A transcutaneous pacemaker is often necessary…

…9 . Delivery of shock (red arrow), with subsequent asystole. ECG 10 . Recurrence of supraventricular complexes (red arrows). ECG 11 . Relapse of VF and new shock…

…shock (i.e. a shock delivered randomly, without considering the phase of the cardiac cycle) to terminate ventricular fibrillation. Cardioversion : Use of synchronized electric shock…

…of cases. Potentially reversible causes of traumatic cardiac arrest ( Salomone et al ): Hypovolemia : Hypovolemic shock is common in both penetrating and blunt force trauma. Loss…

…of myocardium at risk. Over 48 hours: urgent PCI is still indicated with continuing ischaemia, shock, serious arrhythmia or acute heart failure. Routine opening of…

…8. Treat sepsis, bleeding, shock, hypoxia and any other underlying cause immediately. 9. Request ultrasound of the kidneys and urinary tract when a postrenal cause…

…complication rate. The femoral artery is the second choice and is often the best in marked shock or during high dose vasopressor treatment, when the…

…for example, ketoacidosis A venous sample is often sufficient if respiratory failure is not suspected Shock with a large arteriovenous difference Arterial sample, sometimes supplemented…

…6 years 0.15 mg · 6–12 years 0.3 mg · 12 years 0.5 mg (0.01 mg/kg) Adrenaline IV (only in shock…

…oral step down or piperacillin–tazobactam 4 g × 3 IV Urosepsis with shock cefotaxime 2 g × 3 IV Standard dose after stabilisation or piperacillin–tazobactam…

…As for the intermediate dose, together with marked hypertension (caution during non selective beta blockade). Dobutamine Cardiogenic shock. Bradycardia (second line treatment). Stress testing (it…

…inpatient : : Metformin Stop in acute kidney injury, hypoxia, shock, before contrast studies and before surgery. A risk of lactic acidosis SGLT2 inhibitor Stop in acute…

…while definitive control of the bleeding has not yet been achieved. Penetrating torso injury with shock. A positive FAST scan in an unstable trauma patient…

…monitoring. Fluid where hypovolaemia is likely, but avoid repeated blind boluses in cardiogenic toxic shock D Plasma glucose immediately. Assess the level of consciousness, the…

…Severe sepsis and septic shock. Already marked hypothermia from another cause — warm the patient instead. Refractory shock in which the bradycardia and reduced contractility of…

…at least one of the following criteria present: haemodynamic instability or cardiogenic shock recurrent or ongoing chest pain refractory to medical treatment life threatening arrhythmias…

…At the other end, roughly two thirds of ICDs implanted for reduced LVEF never deliver an appropriate shock, so the false positive burden is substantial…

…and may include: Chest discomfort Fatigue Weakness Presyncope or syncope Exercise intolerance Symptoms of shock in advanced cases The presentation may be abrupt or subacute…

…elevation myocardial infarction (STEMI), non ST elevation ACS (NSTE ACS), or ACS complicated by cardiogenic shock. In NSTE ACS, a strategy involving coronary angiography and…

…disease, ST segment elevation myocardial infarction, and cardiogenic shock. Patient related and procedural risk factors The risk of adverse events is increased by: advanced age…

…regurgitation, coronary malperfusion, myocardial ischaemia, heart failure, shock and cerebral or visceral malperfusion. Type B disease may produce rupture, renal, mesenteric or limb malperfusion, spinal…

…In severe cases, bradycardia may progress to hemodynamic instability, presenting as shock or cardiac arrest manifesting as bradyarrhythmic arrest, asystole, or pulseless electrical activity (PEA…

…Coronary spasm, microvascular dysfunction, coronary embolism, coronary dissection, hypotension, shock, respiratory failure, severe anaemia, sustained bradyarrhythmia Increased myocardial oxygen demand Sustained tachyarrhythmia, severe hypertension, hypertensive…

…myocardial ischemia Deterioration in ventricular function Hemodynamic instability Periprocedural myocardial infarction Cardiogenic shock Cardiac arrest The severity may be disproportionate to the angiographic appearance of…

…limitation to acute coronary syndrome (ACS), ventricular arrhythmia, heart failure or cardiogenic shock. In chronic coronary disease, the principal symptomatic indication for revascularization is angina…