Cardiogenic Shock

Start Peripheral Vasopressors Early in Shock!

EMKF

It has been dogmatically believed that prolonged infusion of any vasopressor mandates placement of a central line.  However, available evidence doesn’t support this.

  1. Diluted solutions of all catecholamines are safe (except Vasopressin) to be administered peripherally via a well functioning 18-20G IV or larger in forearm (no hand/wrist/AC) .
  2. No old IVs (>72 hrs)
  3. Know how to treat extravasation
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Acute Heart Failure and Cardiogenic Shock

EMKF

Acute Heart Failure & Cardiogenic Shock

  1. There’s minimal or no role for the administration of loop diuretics (Furosemide/Lasix) early in the management of Acute Pulmonary Edema. The majority of patients aren’t volume overloaded.
  2. Immediate care should focus on Non-Invasive Positive Pressure Ventilation and administration of nitroglycerin.
  3. In patients with End Stage Renal Disease, dialysis is what’s ultimately going to fix the patient.

 

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