Emergency care for cardiogenic shock: an algorithm of action. Resuscitation Emergency Brigade
Acute cardiovascular failurerefers to life-threatening conditions. By the mechanism of development, it is divided into right and left ventricular OCH. Both these conditions often result in death. To save a person, an ambulance must immediately begin resuscitation.
The most common is left ventricular cardiacfailure. It usually follows myocardial infarction, severe rhythm disturbances and other dangerous conditions. To the types of OSS include acute cardiogenic shock. It is caused by severe lesions for the body, in which the heart can not pump blood in the normal regime.
The concept of cardiogenic shock
Emergency care for cardiogenic shockis necessary in the first minutes of its development. It should be remembered that this complication will not pass by itself. And in the absence of urgent treatment will lead to death. Cardiogenic shock is a syndrome in which cardiac output decreases. Despite the compensatory increase in vascular resistance, the body can not cope with this complication without the help of doctors.
Its main manifestations include a decreasearterial and pulse pressure, diuresis, loss of consciousness. If assistance is not provided in time, death from cardiogenic shock occurs within a few hours after the development of the disease. This state does not arise on its own. He is always preceded by acute pathologies of the cardiovascular system.
What causes lead to cardiogenic shock?
The causes of heart shock are differentcardiological and vascular diseases. The most common etiological factor is myocardial infarction. At the same time cardiogenic shock develops only with massive tissue necrosis and lack of first aid. Also, for frequent reasons of its occurrence, life-threatening arrhythmias are considered. They can disturb a person for many years. But with their aggravation and decompensation, these conditions are complicated by shock.
In some cases, the development factor of acuteHeart failure is considered a violation of vascular tone. This happens with massive bleeding, pain syndrome, arthritis. It must be remembered that cardiogenic shock is not an independent disease, but a complication of the underlying pathology. Therefore, doctors need to do everything to prevent its development.
Cardiogenic shock: classification of the disease
Depending on the cause and pathogenesis,several forms of cardiogenic shock. Each of them has its own development mechanism. Nevertheless, all variants lead to the same symptoms. Regardless of the cause of its appearance, emergency care for cardiogenic shock is necessary in any case. Since this state is always equally dangerous. There are following types of this complication:
- A true cardiogenic shock. It develops when the tissue of the heart is damaged. In most cases this form is caused by transmural myocardial necrosis.
- Arrhythmic shock. To its causes include fibrillation and flutter of the ventricles, extrasystole, severe bradycardia. In addition to arrhythmias, shock can lead to a violation of conduction of the heart.
- Reflex cardiogenic shock. In this variant, the violation of the heart functions does not precede the complication. Usually it develops with massive blood loss, kidney failure.
- Areactive shock. Is the most dangerous option. It is isolated in a separate group, since it almost always leads to death and is not amenable to treatment.
True cardiogenic shock: the mechanism of development
True heart shock occurs most often. It occurs if the majority of the myocardium is affected (from 50% or more). In this case, the necrosis extends not only over the entire thickness of the muscle, but also occupies a large area. In addition to heart attack, other diseases can lead to a true shock. Among them: septic endocarditis, severe heart defects, decompensated myodystrophy, etc. Also, severe cardiac disorders are caused by acute hyperthyroidism, some genetic pathologies.
As a result of necrosis of the heart tissue, the contractilethe ability is greatly reduced. Therefore, the body can not work in full force and provide blood vessels. Minute volume also decreases. This increases the resistance of blood vessels. Despite this, the heart still does not cope with their work. The result is a disturbed blood supply to all organs and tissues.
Pathogenesis of arrhythmic cardiogenic shock
At the heart of this form of the disease are violationsconduction and rhythm of the heart. They can arise as spontaneously (as a result of myocardial infarction), and develop gradually. Most often, arrhythmias trouble the patient for many years. The same applies to conduction disorders. Nevertheless, life-threatening conditions develop within a short period. It's about hours and even minutes. Most often, cardiogenic shock is caused by abnormalities of the ventricular rhythm. Among them: tachycardia, which turns into fibrillation, and flutter. In addition, these processes can lead to frequent group extrasystoles.
Another condition that can lead to shock,is a sinus bradycardia. The decrease in heart rate is usually characterized by conduction disorders. Less often, cardiogenic shock results in fibrillation and atrial flutter. As a result of pathological contractions and ectopic foci in the myocardium (extrasystoles), the heart can not perform its function. Therefore, there is a decrease in the impact and minute volume, a drop in pulse pressure, blood pressure. With this option, an ambulance must first stop arrhythmia by defibrillation or artificial heart massage.
What is a reflex shock?
This form of shock develops due to reasons,initially not associated with defeat of the heart muscle. The trigger mechanism for such a complication can be severe pain or bleeding. However, these symptoms are rarely associated with the heart. Usually such a shock is diagnosed after an accident, acute renal failure.
This option has the most favorableforecast. Emergency care for a cardiogenic shock of a reflex character should be aimed at eliminating its cause - pain syndrome, as well as stop bleeding. Due to these factors, the regulation of vascular tone is impaired. Because of this, the blood stagnates in the veins and arteries, and in the interstitial space the fluid swims, forming an edema. All this leads to a decrease in the venous influx to the heart. Further, the mechanism is the same as in other forms.
The causes and pathogenesis of an arecative shock
An arterial cardiogenic shock occurs ifthe entire myocardium is affected. This occurs with repeated heart attacks. Also, the cause can be a cardiac tamponade. In this case, a liquid appears in the pericardium, which squeezes the organ, preventing it from contracting. In some cases, tamponade can lead to heart rupture. This condition leads to death. Unfortunately, the patient can not be helped in this case. The mechanism of development of shock is associated with the complete cessation of the work of the heart, in contrast to other forms in which the minute volume decreases. The mortality from this complication is close to 100%.
Symptoms of cardiogenic shock
The clinical picture is the same, regardless ofthe cause of the cardiogenic shock. Symptoms of complications are as follows: a drop in arterial and pulse pressure, tachycardia, oliguria (decreased diuresis). Depending on the value of blood pressure and clinical data, 3 degrees of severity are distinguished. When examining the patient, you can identify other signs of cardiogenic shock. These include:
- Cold and sticky sweat.
- Fear of death or lack of consciousness.
- Cyanosis - cyanosis of the skin.
- The facial features of the patient can be pointed, facial expressions - suffering.
- Skin color with a serious degree acquires a gray tinge.
How to diagnose a shock?
Diagnosis of cardiogenic shock usuallyis based on clinical data and the questioning of the relatives of the patient. Since it is necessary to act immediately, doctors evaluate blood pressure, skin condition, pupil response, heart rate and respiratory rate. If the patient has signs of shock, immediate help is immediately available.
In the presence of free medical personnelan anamnesis of the disease is revealed. The doctor asks: did the patient suffer from arrhythmia, angina pectoris, possibly, suffered a myocardial infarction earlier? If the complication develops at home or in the street, the diagnosis of shock by ambulance doctors ends here. When the patient is kept in the intensive care unit, in addition, pulse pressure, vascular resistance, and urine output are measured. The gas composition of the blood is also investigated.
Cardiogenic shock: first aid, algorithm of actions
It is worth remembering that from how quickly andQuality of care is provided, the patient's life depends. With signs of such a complication, doctors begin to take action immediately. If you do everything in time, you can defeat cardiogenic shock. Emergency help - the algorithm of actions is as follows:
- Lay the patient in a horizontal position with a raised foot end. In addition, it is necessary to provide air access (unfasten clothing, open the window).
- Supply of oxygen. It can be carried out through a special mask or nasal catheter.
- Anesthesia. With myocardial infarction and reflex shock, narcotic drugs are used for this. The most commonly used medication is Morphine. It is diluted in physiological saline and injected iv slowly.
- Recovery of bcc and blood flow. To do this, the introduction of a solution of "Reopoliglyukin".
- If there is no effect, it is necessary to increase blood pressure with the help of the drug "Atropine" 0.1%. Enter in an amount of 0.5-1 ml.
In addition, it is necessary to eliminate the cause of the shock. With myocardial infarction, thrombolytic and antiplatelet therapy is performed (preparations of Alteplase, Clopidogrel, Aspirin). Also for dilution of blood use a solution of "Heparin". With ventricular rhythm disturbances, the medication "Lidocaine" is administered. In some cases, defibrillation is necessary.
Emergency hospital care
Emergency care for cardiogenic shockcontinues in the intensive care unit. There is intensive therapy, constant monitoring of indicators, the causes of complications are clarified. With myocardial infarction, surgical treatment is performed - bypassing the arteries, establishing a stent. Also, surgical care is needed for certain arrhythmia and conduction disorders. At the same time, an artificial pacemaker is installed, which performs the contractile function of the heart.