EM Educator Series: Challenging Diagnosis of Cardiogenic Shock

Authors: Alex Koyfman, MD (@EMHighAK) // Edited by: Brit Long, MD (@long_brit) and Manpreet Singh, MD (@MprizzleER)

Welcome to this week’s EM Educator Series. These posts provide brief mini-cases followed by key questions to consider while working. The featured questions provide important learning points for those working with you, as well as vital items to consider in the evaluation and management of the specific condition discussed.

This week has another downloadable PDF document with questions, links and answers you can share with learners as educators in #MedEd. 

Case:

A 62-year-old male presents with chest pain, dyspnea, and diaphoresis. He appears ill, with VS RR 24, HR 90, BP 72/41 mm Hg, Sat 90% on RA, T 37C. His ECG demonstrates ST elevation in V1-V4, with reciprocal changes, and bedside US demonstrates diffuse B lines and extremely poor ejection fraction.

Considerations:

1. What are the etiologies of cardiogenic shock?
2. What does the RUSH exam entail?
3. What will the physical exam demonstrate, and what are its limitations?
4. What is the medical management of cardiogenic shock?
5. How do you optimize this high-risk intubation?
6. When the ship is sinking, who else can help?

Suggested Resources:

• Articles:
  • emDOCs – Cardiogenic Shock
  • R.E.B.E.L. EM – Cardiogenic Shock
  • EM in 5 – Cardiogenic Shock
  • emDOCs – RUSH (“Rapid Ultrasound for Shock”) Protocol
  • First 10 EM – Undifferentiated hypotension
  • emDOCs – The Hypotensive ED Patient: A Sequential Systematic Approach
• Podcasts:
  • EMCrit RACC – Podcast 10 – Cardiogenic Shock