0071643192.pdf

■ Valvular disease
■ Ventricular septal defect

DIAGNOSIS

■ For most causes essential tools will include ECGandechocardiography.

TREATMENT

■ Will depend on underlying cause
■ Goal is to improve myocardial contractility and pump function.
■ Ensure adequate ventilation and oxygenation.
■ Decrease work of breathing.
■ Inotropes for depressed LV function
■ Dobutamine
■ Primarily a β 1 -adrenergic agonist →improved myocardial contrac-
tility and augments diastolic coronary blood flow.
■ Dopamine
■ At moderate doses (5–10 μg/kg/min) has α- and β 1 -adrenergic effects.
■ Intra-aortic balloon pump as bridge to revascularization or valvular repair

Obstructive Shock

Obstructive shock occurs when an extra cardiac obstruction impedes cardiac
filling or emptying.

ETIOLOGIES

Etiologies include:

■ Cardiac tamponade
■ PE
■ Tension pneumothorax

TREATMENT

■ Relieve obstruction to flow.

Distributive Shock

In distributive shock impaired tissue oxygenation results from a combination
of vasodilation with peripheral pooling, capillary leak, and relative cardiac
dysfunction.

There are four major causes of distributive shock: Sepsis or systemic inflam-
matory response syndrome (SIRS),anaphylaxis,rewarming in severe hypother-
mia, andneurogenic shock. Toxic shock syndrome (TSS) is a variant of septic
shock and is discussed briefly.

SEPSIS ANDSIRS

Sepsis and SIRS are the result of a complicated cascade of cytokines and
other immuno and inflammatory modulators.

CAUSES

Triggers include

■ Infection (sepsis)
■ Equal frequency between Gram-negative and Gram-positive organisms
■ Trauma

RESUSCITATION

Four causes of distributive

shock:

Sepsis/SIRS

Anaphylaxis

Rewarming (severe

hypothermia)

Neurogenic shock

Clinical cardiogenic shock will

occur if 40% of the left

ventricle loses contractile

function.