cardiogenic shock classification

Cardiogenic Shock: SCAI Stage Classification

With a close to 50% mortality rate for cardiogenic shock, we all need a do a better job of caring for these patients. A cardiogenic shock classification would help identify who needs the most help.This is created for anyone caring for cardiogenic shock including physicians, APPs and nurses.We are all in this together. The earlier …

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dka saline lactated

Saline or Lactated Ringers/Plasma-lyte for DKA Resuscitation?

When patients present to the ED in DKA, should we resuscitate them with 0.9% sodium chloride (saline) or balanced salt solutions such as plasma-lyte or lactated ringers?Many DKA order sets use 0.9% sodium chloride "aka normal saline" as their initial fluid of choice.We know these patients are dry when they arrive to the ED.They need …

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cardiogenic shock norepinephrine epinephrine

Norepinephrine or Epinephrine in Cardiogenic Shock: Is One Better?

Which should be the first-line vasopressor between norepinephrine and epinephrine in cardiogenic shock?Your patient had an MI and is now in cardiogenic shock.They are hypotensive and need a vasopressor.To clarify, The Crit Doc of Tik Tok aka CriticalCareNow aka Haney Mallemat likes epinephrine as an inotrope, not a vasopressor.This was a pilot study, meaning that …

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cardiac arrest cath lab

When to Take Cardiac Arrest Patients to the Cath Lab

A patient has a cardiac arrest and ROSC was achieved.They present to the ER or ICU.Suspicion is high that this was a cardiac insult.The EKG, though, does not show a STEMI.Troponins are elevated. The patient has a cardiac history.Have you ever wondered why intensivists never ask cardiology to take the patient to the cath lab …

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glucocorticoid

Rethinking Corticosteroid/Glucocorticoid Dosing in COVID-19

SARS-CoV-2 is a virus that kicks off an inflammatory disorder in certain individuals. That's what data says and that's what most of us have seen. Inflammatory markers through the roof on the sicker patients, those who end up in my ICU. We start glucocorticoid therapy such as dexamethasone or methylprednisolone and the inflammatory markers drop, …

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cardiogenic shock swan

Cardiogenic Shock & Swan-Ganz/Pulmonary Artery Catheters

Mortality for patients in cardiogenic shock is finally improving to be less than 50%. It had been hovering at 50% for decades. Would floating a Swan Ganz catheter, also known as a Pulmonary Artery Catheter improve outcomes in Cardiogenic Shock? The ESCAPE trial took the winds out of the sails of the Swan-Ganz enthusiasts in …

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pulmonary artery pulsatility index

Pulmonary Artery Pulsatility Index (PAPi)

In an effort to not fly blind in patients with advanced heart failure or cardiogenic shock, certain equations exist to help us manage our patients. This helps us identify who is not doing well and act on their deterioration before it really hits the fan. To measure how the left heart is doing, we use …

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bicarb dka

Bicarb in Diabetic Ketoacidosis (DKA): One Minute Journal Club

This is a one minute journal club. This is not medical advice. The full breakdown in below this snippet.Read the data for yourself.Should we provide our DKA patients with sodium bicarbonate (bicarb) to improve their pH?We want to make the numbers pretty.We want to fix the acidosis faster, but does this work?The first thing people …

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milrinone dobutamine

Milrinone or Dobutamine in Cardiogenic Shock?

Is your institution a milrinone shop or a dobutamine shop? Or do you have a mixed shop?It seems that most institutions are accustomed to use mostly one or the other in cardiogenic shock.Some argue that milrinone is better.Some argue that dobutamine is better.But do we know the answer?This was answered late in 2021 in the …

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nitric oxide Epoprostenol

Nitric Oxide and Epoprostenol (Flolan) Use in Cardiac Surgery

We all wish that every patient who goes into cardiac surgery would be a straight-forward fast track case. Unfortunately, the issues that lead most patients to need cardiac surgery also put them at risk for complications. Some patients present with pulmonary hypertension that is discovered in the operating room once the pulmonary artery catheter is …

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