Cardiogenic Shock

Regarding Extracorporeal shockwave therapy 1X3 - Left Shoulder, CA MTUS does not specifically address this issue. ACOEM and ODG recommended shockwave therapy for calcifying tendinitis but not for other shoulder disorders. This is a chronic pain patient with a 2014 date of injury. The patient has significant left shoulder pain. However, the latest progress note indicated that psychical exam revealed full ROM and no tenderness to palpation over the shoulder joint. In addition the guidelines do not recommend shockwave therapy for sprain/strains or laceration of the shoulder. Furthermore, the latest progress report discussed about continued shockwave treatment. It is unclear, if shockwave therapy has been provided before. Medical necessity has

The early intravenous fluid administration for resuscitation of the critically ill hypovolemic patient is the corner stone of shock therapy (Kruemer & Ensor 2012). The Surviving Sepsis recommends early optimization in the first six hours, followed with fluid challenges in the case of persistent hypo

Cardiogenic shock is a frequently fatal complication that occurs when the heart cannot pump an adequate amount of blood in order to perfuse tissues. This hypoperfusion causes multiple organ dysfunction and damage which classifies cardiogenic shock a medical emergency. In the past, cardiogenic shock had a poor prognosis. However, currently approximately half of the people that go into cardiogenic shock survive (National Heart, Lung, and Blood Institute [NHLBI], 2011).

○ An epinephrine injection helps to manage life-threatening allergic reactions, but you still need to go to the emergency room even if epinephrine seems to work. This is important because anaphylaxis may happen again within 72 hours (rebound anaphylaxis).

Shock is described as life threatening medical emergency resulting from insufficient blood flow through the body (Huether & Mccance, 2012) There are five types of medical shock. These include septic shock, anaphylactic shock, cardiogenic shock, hypovolemic shock, and neurogenic shock (Huether & Mccance, 2012).

Furthermore, prompt infusion of antimicrobial agents ought to be priority and this may require extra vascular access ports (Dellinger, et al., 2008). Early goal-directed resuscitation has confirmed to improved survival for emergency department patients presenting with septic shock in a randomized, controlled, single-center study. Resuscitation lessen 28-day death rate (Dellinger, et al., 2008). In a reviewed conducted by Dellinger, et al., (2012) advocated administering one litre of crystalloid or 300-500ml of colloid more than 30 minutes, to accomplish a central venous pressure (CVP) of 8 mm Hg to 12 mm Hg. Volumes ought to be increased if there are huge indications of hypoperfusion (Dellinger, 2014).

Evidence-Based Practice, Step by Step: Asking the Clinical Question: A Key Step in Evidence-Based Practice

Cardioversion. During this procedure medicines or an electrical shock are given to make the heart beat normally.

The unresolved infection has landed the patient on septic shock. Sepsis is the body’s response to inflammation of a particular or unknown infection. The presence of hypotension despite adequate fluid infusion and inadequate tissue perfusion is the result of septic shock. The treatment of shock is centered on the restoration of blood pressure to normal, the presence of adequate tissue perfusion, making sure organs return to functioning well, and avoiding further complications (Lewis, Dirksen, Heitkemper, Bucher, & Harding,

Along with potential biomarkers, research has focused on how to best treat patients with sepsis and septic shock. The current recommendations include giving IV antibiotics within 1 hour of recognition of sepsis and a minimum of 30 mL/kg of IV crystalloid fluid within the first three hours (15). This is followed by frequent reassessment and further fluid administration based off of the hemodynamic status of the patient (15). While the guidelines are widely used by practicing physicians, there are concerns about the aggressive fluid resuscitation (16-17). Some researchers are suggesting the use of ultrasound imaging techniques to help monitor the volume status of patients

Sepsis is a phenomenon in which an infective agent results in a physiological response in excess of the pathogenic insult. Efforts to define and investigate sepsis have been somewhat fruitful in elucidating the nuances of this phenomenon. Yet, gaps exist in identifying and investigating sepsis. Recent efforts have streamlined the definition and identification criteria of sepsis and septic shock. The treatment of sepsis is based on the elements of identification, hemodynamic interventions (fluid and vasopressor resuscitation), and antimicrobial therapy/source control. A two-tiered approach employing the qSOFA (Quick Sepsis-Related Organ Failure Assessment) and SOFA (Sepsis-Related Organ Failure Assessment) tools now provide a succinct criteria for sepsis and septic shock. Various approaches may be taken to assess fluid responsiveness, provide fluid resuscitation, and determine the need for vasopressor support. Early, aggressive antimicrobial therapy is essential to the treatment of sepsis. Obtaining source control and considering early surgical

Emergency medical technicians are licensed and/or certified health-care providers that are out-of-hospital. They immediately respond to the scene of an emergency, assess the safety hazards of the scene, and transport patients to institutions. (Beck, 2013) An emergency medical technician-paramedic takes on the additional tasks of giving medication and using various complex equipment. The competence and hasty reactions of EMTs can save the lives of patients and get them to the emergency room physician. Although education differs state to state, every emergency medical technician-paramedic must receive a high school diploma or GED and become certified for cardiopulmonary resuscitation (CPR). (“Emts and paramedics,” 2014) They must also

Early hemodynamic assessment on the basis of physical findings, vital signs, central venous pressure, and urinary output fails to detect persistent global tissue hypoxia. A more definitive resuscitation strategy involves goal-oriented manipulation of cardiac preload, afterload, and contractility to achieve a balance between systemic oxygen delivery and oxygen demand. End points used to confirm the achievement of such a balance (hereafter called resuscitation end points) include normalized values for mixed venous oxygen saturation, arterial lactate concentration, base deficit, and pH. Mixed venous oxygen saturation has been shown to be a surrogate for the cardiac index as a target for hemodynamic therapy. In cases in which the insertion of a pulmonary-artery catheter is impractical, venous oxygen saturation can be measured in the central circulation (p. 1368).

Next we have Cardiac tamponade [which is caused by blunt or penetrating trauma or a few medical conditions such as cancer or autoimmune dieses] which is a serious condition where the blood accumulates in the pericardial sac [the sack around the heart]. While there is no definitive treatment on a basic level and ALS provider can relieve fluid with a needle in a risky but necessary procedure the last form of cardiogenic shock is a pulmonary embolism. A pulmonary embolism is when there is a blood clot blocking the flow of the pulmonary veins leading to obstructive shock and causing heart failure. Interesting enough to mention is the fact that one of the more common causes to cardiogenic shock is damage to the heart muscle however just because you have a heart attack does not necessarily mean you have had caridogenic

Assessment Although a patient in severe sepsis may be transferred to the intensive care unit (ICU), medical-surgical nurses must be able to recognize early signs and symptoms of sepsis to ensure prompt treatment before the patient requires ICU admission. Severe sepsis Severe sepsis occurs when a patient with documented sepsis goes on to develop acute organ dysfunction with hypoperfusion and tissue hypoxemia. Simple prevention strategies Without proper assessment and early identification, patients with sepsis can deteriorate quickly, suffering compromised tissue oxygenation and organ dysfunction for many hours. Be aware that although blood pressure readings are crucial in assessing and planning care for the septic patient, mean arterial pressure