Shock due to the heart not pumping properly
Something stops your heart pumping; this is bad. Here's a list of somethings:
- Tension pneumothorax
- Cardiac tamponade
- Myocarditis/myocardial depression (usually due to drugs, hypoxia, acidsosis, sepsis)
- Aortic dissection
Depends on the cause.
- Give high-flow 100% O2
- Diamorphine 2.5-5mg for pain/anxiety
- Correct arrhythmias, electrolyte abnormalities and acid-base disturbance
Generally, by this point they'll have all sorts of clever stuff like a central line in. This allows you to measure stuff and it you can measure Pulmonary Capillary Wedge Pressure (PCWP). (They ram a pressure-measuring device as far into the lung as possible. It's wedge shaped. It gets stuck. You measure the pressure.) If PCWP <15mmHg
- Give plasma expander (typically colloid) 100ml/15min iv. Aim for PCWP 15-20mmHg.
If PCWP >15mmHg
- Dobutamine (inotropic support) 2.5-10 micrograms/kg/min. Aim systolic BP >80mmHg.
If both these fail, consider:
- Dopamine 2.5microgrames/kg/min via central line
- Intra-aortic balloon pump
Treat the cause when you can.