Micro-lectures

Paramedics Course – Cardiogenic Shock

Paramedics Course – Cardiogenic Shock

Micro Lecture by the Australian Paramedical College

 

In this micro-lecture, we discuss Cardiogenic Shock and their different classifications. Enrolled students have unlimited access to a rich library of learning materials such as this.

 

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Today we’re going to talk about cardiogenic shock. Now, depending on which classification tool you use, you will notice that there are slightly different classifications of shock.

Well, let’s start by defining shock.

Shock is simply a lack of oxygen at the level of the tissues. Therefore, your tissue cells then start to swell up, and they then start to die and become irreversibly destroyed. That’s the process of hypoxic cell death.

Now, luckily, as paramedics, we can prevent that if we arrive on scene quickly enough. We have the right equipment, the right tools, the right mindset, and, of course, we have the right scope of practice, and, of course, time. We have to make sure we’re there quickly enough. But it basically is reversible, depending on all those factors.

So let’s take a look at cardiogenic shock. So cardiogenic shock occurs when the heart itself is not pumping blood adequately to be able to deliver the blood to the tissues. So it’s really important that we know a little bit about it and some of the effects of it.

Now, when you look at this image, the first thing I don’t want you to do is panic and think, “Wow, that’s a complex image.” Instead, just break it down. So what it’s saying on this image, is at the top it’s giving you reasons why you might go into cardiogenic shock in the first place.

And it’s saying myocardial infarction, which is causing myocardial dysfunction. So one causes the other. What you’ll also notice is that it’s broken it down into the effects of cardiogenic shock on the systolic and the diastolic blood pressure.

So let’s start at the top. So when you have a myocardial infarction, there is usually a systemic inflammatory response, which is your body’s way of trying to relieve the cause. As a result, you end up with reduced cardiac output and reduced stroke volume. So cardiac output is the amount of blood that the ventricle pumps, so the volume. The stroke volume … So the cardiac output is the complete number. So the stroke volume is how much within every single stroke. So they’re two of the same thing, but they’re also slightly different when you break it down over a period of a minute.

Systemic perfusion is dropped. You end up with low blood pressure, so systemic just means the entire system, and the reduced coronary perfusion pressure, So in other words the amount of pressure within the coronary arteries. And rightly so, you can see that it leads to ischemia, which means a lack of oxygen. Now, as a result of all of this, you end up with compensatory vasoconstriction. In other words, your body will naturally vasoconstrict, leading into an even worse situation. It’s basically your body … it thinks it’s trying to do the right thing, but it’s actually making the whole thing worse.

On the other side, you’ve got an increase in the left ventricular end diastolic pressure. In other words, your heart left ventricle is trying so hard to continue to pump that blood that it’s working really, really hard, so that the work that it’s doing is going up, but the actually amount of blood that it’s pumping out is going down. That leads to hypoxemia, lack of oxygen in the … -emia is blood, so it’s the lack of oxygen, leading to ischemia, and, again, progressive myocardial dysfunction and death.

What you can see here on the right, is that the moment we’re able to revascularize, in other words put a stent in, for example, it relieves this ischemia, because that … At the center of this entire diagram is ischemia, lack of oxygen. So that’s a summary of cardiogenic shock. I hope you’ve found it useful for your studies. My name’s Sam Willis, and I look forward to speaking to you again shortly.

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