David Farsey explains cardiogenic shock as a state where the heart fails to pump blood effectively, dropping ejection fraction from normal 55-60% to as low as 5-10%. Treatment involves push-dose epinephrine to boost the heart's strength and sometimes fluid boluses despite pulmonary edema, prioritizing organ perfusion over fluid balance.
Foreign.
We're going to talk about cardiogenic shock. Let's look first at the word shock. Shock means it's a hypoperfusion state, meaning we're not getting blood to the right organs. Blood pressure is defined less than 90. Right. But 90 is just a number, right. We don't know where patients live. And that's really crucial to understand because if I, David Farsey, live at a systolic blood pressure of 160 and now you come and roll on me because I'm having shortness of breath and now suddenly my pressure is 110, that's relatively low, right. For me. Right. So numbers are numbers. Right again. And you'll hear in my, especially for lectures based on done by me, numbers are numbers. Treat your patient. But by definition, systolic blood pressure less than 90, sign of hypoperfusion, right? They have, they're cyanotic, they, they, they have edema of the lower extremity. They have pulmonary, pulmonary edema. But it's really they and the tachycardia, they're trying to compensate. So cardiogenic shock, right? It's caused by the heart. The heart has gone to a point where it can't tolerate, can't do the job anymore. And now suddenly it's just collapsing. So when we talked about that ejection fraction normal, 55 to 60, now it's down to 10. And then, because in cardiogenic shock it might be down to five. And so think of.
The blood supply to the lungs, to the brain, to the kidneys, to the liver. Not seeing any more blood. It's absolutely not seeing any blood. It's in complete shock. The train is not bringing oxygen to those organs. And those organs are gonna die. Right? And that patient's gonna die. So what do we do? Well, we're gonna give medication. You have your push dose pressor, now you push dose pressors is epinephrine, right? Epinephrine is an alpha 1, 2 and a beta 1 and beta 2. Alpha 1 is the heart. So as inotropic, it's going to increase the strength and chronotropic is going to increase the speed. Think of a choo choo train, right? I use that example of the choo choo train every everywhere. The choo choo train, right. Which is the locomotive of the train is your heart, the box, the wagon, the wagons are your blood and this four space which is the oxygen, right? So if the choo choo train is going, leaving the heart to feed brain city, liver city, kidney city. What are you going to do? You can shrink the track, right? You can shrink the track, make the track shorter so it doesn't have to do 50 miles, it only has to do 25 miles. That's going to be your Alpha 2. And then you can increase the speed of the train to go faster. That's Alpha 1 and Alpha and Beta 1 receptors. And then you can increase the buck scar by adding blood. But we don't have. We're not going to talk about blood in this protocol yet. Maybe one in the future. And so post dose EPI is going to do all this. Increase the train, increase the speed and bring the blood. The problem by giving push dose EPI is what happened. Now you've made the tank smaller, Right? Because you vasoconstricted the tract, the tank. Right. Remember, in acute pulmonary edema, we're using nitroglycerin to vasodilate. Right. To vasodilate. Now we're doing the opposite. That's confusing, right? Not really. Think of it as the heart is dying. We have no option. We're just trying to get the heart to squeeze enough blood to bring to the train so it can deliver oxygen to the organs. And so what else can we do? We can give a liter of normal saline. I know that goes against everything that we're teaching you, right? Pulmonary edema. They're drowning. Oh, no. We need to diurese. We need to do all these things. But now we're going to give a liter of fluid. Cardiogenic shock. They are dying where their organs are dying. We need to increase the ability for the blood to try to squeeze as little as it can, but enough to feed the train.
