By Zach Adams MD, OSUEM PGY2 // Edited by Michael Barrie MD, OSU EM Assistant Professor
A 65 year-old patient presents with a history of ischemic cardiomyopathy and multiple medical co-morbidities. Initial triage vital signs show a BP of 83/40 with a pulse of 120 and oxygen saturation of 92%. He appears in extremis.
On initial evaluation, the patient is mentating well but complaining of shortness of breath. Heart sounds are distant and lungs are otherwise clear. You note mottled peripheral extremities, which appear cyanotic and are cold to touch. He tells you that he was recently hospitalized, but does not know what and whether or not he is still being treated.
While obtaining initial lab studies and getting the patient hooked up to the monitor, you perform a RUSH exam and note extremely poor systolic function of the left ventricle and the IVC is distended without respiratory variation. You suspect this is cardiogenic shock. What is cardiogenic shock? What are your next steps in management?