Cardiogenic Shock

Tom RaderStaff - June 1, 2021

Cardiogenic shock is due to inadequate pumping of the heart. The most common cause of this is a heart attack. Your patient will complain of chest pain
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This is the first I’m hearing of pulse checking as part of CPR. How do you balance checking for pulse with maintaining rhythm/momentum/pressure from chest compressions?

Do you know why pulse checking was not covered in the Red Cross CPR course I took? Also, that same Red Cross course recommended only 1 second long rescue breaths (during CPR) — do you know why that recommendation is different?

How does all of this compound with opioid overdose? If patient is not breathing and has no pulse, then chest compressions; if you start to feel a pulse, but no breathing, switch to rescue breaths; if they start breathing normally but are not fully awake, administer naloxone?

 

Pulse checking is part of the Primary Survey CABC steps — the second C, for Circulation. So it’s one of the very first things you check when coming up on an unresponsive patient. You wouldn’t see an unresponsive person and immediately jump into CPR chest compressions. You’d first check CAB, and assuming those are clear but then there’s no pulse, start CPR. 

CPR lesson talks more about when to use rescue breaths. In short, you won’t be alternating between compressions and rescue breaths, it’s one or the other. 

If the CPR works to bring the patient back (rather than “just” buying time), you’ll probably know it without checking for pulse. But if you’re pumping away and not sure what’s happening, stop and check a 15-second pulse.

You nailed the opioid example. Although I might not give narcan if I can instead hand them off to professional help now that they aren’t imminently dying.

 

Is there ever a point where chest compressions become a bad idea? For example, if there’s a chest wound, even with a chest seal over it, that seems super dicey, but I guess you gotta do what you gotta do (if they don’t have a pulse, they are going to die, so do chest compressions until you’re exhausted, EMS arrives, etc.)

 

You answered it. Yeah, you clearly could cause more damage in that case, but they’re going to die anyway if you don’t get the pump restarted.

 

Have you ever considered having an AED on you, perhaps in a VFAK? They’re *very* pricey.

 

Not really. The cost vs. benefit doesn’t make sense for random civilians, at least not for the foreseeable future. Besides cost, bulk, weight, etc., the set of circumstances where an AED helps is narrower than people think. I’d only choose to have one if someone in my immediate family had a history of sudden cardiac arrest.

 

My condolences on your mother. This was a very powerful story. Thank you for sharing.

 

Something I recently learned that may be an important tidbit to be mindful of if prepping in a family or a group with diabetic patients: I didn’t realize diabetics can have such severe nerve damage that they can’t feel the chest pain associated with a heart attack. Uncontrolled diabetes can lead to nerve damage and a lack of pain perception in areas like the chest. One of my diabetic family members recently had a “silent heart attack” with no chest pain whatsoever-it was only caught because he was getting an ECG. 

 

What a mind-trip it would be to suddenly be told “oh, you had a heard attack and didn’t know it.” Would be scary going through life knowing you won’t even be aware of the symptoms.

 

I was told that doing/continuing CPR even if patient is dead was good in the prospect of organ donation. Is that correct ?