Shock Following AMI
A 49-year-old man was found slumped in his living room chair, cool and clammy but still breathing. His wife called 911. The EMS transported him to the local emergency room. On arrival, his vital signs were as follows:
Oxygen at 60% by facemask had been initiated in flight, as well as intravenous normal saline running wide open, 450 mL having already infused. Dopamine was started at a rate of 5 mcglkg/min. A stat ECG showed "tombstone" ST devation in the anterior leads {V2, V3, VJ, with reciprocal changes in leads II, III, and a VF. The patient was taken for immediate PTCA. In the laboratory, cardiac cathckrization findings were as follows:
On return to the ICU, the nurse obtained hemodynamic parameters as follows:
What i1 the mo1t likely cau1c of the patient'• shock?
(A) Hypovolemic
(B) Distributive
(C) Cardiogenic
(D) Neurogenic
What will be the primary goal caring for this patient after PCI?
(A) Reduce myocardial workload
(B) Dilate the pulmonary vascular bed
(C) Administer a diuretic
(D) Intubate the patient to improve oxygen delivery
You anticipate the next intervention for this patient will be:
(A) Initiate a vasodilator to reduce afterload
(B) Give volume to improve preload
(C) Titrate the dopamine infusion up to 7.5 mcg/lcg/min
(D) Insertion of an intra-aortic balloon