Category Archives: Cardiogenic Shock

Category: Cardiogenic Shock   |   Date:

When administering a fluid bolus to a cardiogenic shock patient, what is our targeted systolic blood pressure? Is it similar to that of a ROSC to target 90 mmHg, or reversing hypotension and targeting 100 mmHg?

Category: Cardiogenic Shock, STEMI Bypass   |   Date:

The ALS PCS 4.5 STEMI directive follows the BLS V3.0.1 criteria and no longer has a pulse rate of <50 as a contraindication for bypass. Does this mean a bradycardic patient with a pulse in the 40’s can now be transported on a STEMI bypass? In the past medics where taught differing regions would have slightly different STEMI receiving acceptance criteria. Are there any considerations we as medics should consider for STEMI receiving hospitals in our governing region?

Category: Cardiac Ischemia, Cardiogenic Shock, CPAP   |   Date:

Question: In the event we have a patient who is STEMI positive, with symptoms of CHF (crackles/pitting edema) who is hypertensive >140 systolic BP are we to treat with 0.8mg of nitro for the CHF or 0.4 mg under the ischemic chest pain protocol? Also with the new STEMI standard dropping down to 3 - 0.4mg SL doses of nitro maximum, will that change out CHF protocol for nitro administration if both problems present together?

Category: Cardiogenic Shock, CPAP, Intravenous and Fluid Therapy   |   Date:

Question: In a patient presenting with respiratory distress, crackles and a relevant cardiac history, I would assume that left ventricular failure/infarct would be a fair working assessment. If 12-lead indicated LV involvement occurring with hypotension that would place the Cardiogenic Shock and CPAP Directives out of parameters.

Crackles = no bolus, hypotension = no CPAP. Other than vitals/cardiac monitoring, oxygenation/ventilatory support as needed, it seems like a situation such as this one may limit pre-hospital management, as far as a PCP scope goes. Any comments or suggestions?

Category: Cardiogenic Shock   |   Date:

Question: As an Advanced Care Paramedic, can I administer dopamine IO?

Category: Cardiac Ischemia, Cardiogenic Shock, Intravenous and Fluid Therapy   |   Date:

Question: On a recent ischemic chest pain call with an approximately 60 year old female patient, conscious and alert, 2 nitro sprays prior to arrival. The 12 lead was normal and I gave ASA, but decided to withhold nitro as I had difficulty obtaining a BP on scene. The patient had no palpable radial or brachial pulses bilaterally. My partner and I made 4 NiBP attempts on scene with no reading on either arm and manual BP attempts bilat with no sound on auscultation or deflection of the needle. I was unable to also confirm the HR that showed on the monitor as she was uncooperative while attempting a carotid (although present). After extricating the patient on a stair chair, I decided to continue my care with an IV TKVO in the truck. I did not want to delay scene time any further. While in the truck I continued to attempt NiBPs which was now displaying a reading of hypertension, yet no pulses other than carotid were palpable. Although the monitor was always showing vitals within my parameters to administer nitro, I withheld it, as I was treating the findings with the patient, not the monitor. She had stated her pulses were usually weak. She remained conscious and alert with no signs of hypotension other than weak/absent pulses. My question is… was I ever justified to administer a bolus to this patient?

Category: Cardiogenic Shock   |   Date:

Question: If I have a patient that appears to be in cardiogenic shock with a STEMI ECG should I be calling for a BH patch to have an order for aspirin after initiating an IV bolus?