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Case: It is cardiogenic shock


Asysin2leads

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Cardiogenic shock patients tend to be a bit hypovolemic, despite the presence of audible pulmonary edema. This does not absolutely indicate that there is enough fluid in the vascular system, just that the fluid that is there is beginning to leak into the pulmonary system. The patient that Asys described sounds typical of a tamponade, although through a different mechanism than trauma.

Use judicious fluid boluses to maintain perfusion. The preload is the problem, not the ability of the heart to constrict, or the arterial blood pressure. This patient needs the fluid to fill the chambers of the heart so that the Frank-Starling mechanism can work.

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This will be hard to manage at best. The problem with endocarditis is from within. It is pretty easy to judge knowing the diagnosis. However, if I was given this patient without all of the follow up information, I would have strongly considered pressors as well. I would have also considered judicious fluid therapy. Once in the hospital, we can pop in a few invasive lines and obtain some hemodynamic values to help guide our therapy.

Take care,

chbare.

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