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❑&nbsp;&nbsp;[[Nitroglycerin|<span style="color: #000000;">Nitroglycerin</span>]] [[IV|<span style="color: #000000;">IV infusion</span>]]
❑&nbsp;&nbsp;[[Nitroglycerin|<span style="color: #000000;">Nitroglycerin</span>]] [[IV|<span style="color: #000000;">IV infusion</span>]]


: ❑&nbsp;&nbsp;oooo
: ❑&nbsp;&nbsp;Initial dose: 5 μg/min
 
: ❑&nbsp;&nbsp;Usual dose: 10–20 μg/min


❑&nbsp;&nbsp;[[Nitroprusside|<span style="color: #000000;">Nitroprusside</span>]] [[IV|<span style="color: #000000;">IV infusion</span>]]
❑&nbsp;&nbsp;[[Nitroprusside|<span style="color: #000000;">Nitroprusside</span>]] [[IV|<span style="color: #000000;">IV infusion</span>]]


: ❑&nbsp;&nbsp;oooo
: ❑&nbsp;&nbsp;Initial dose: 0.3 μg/kg/min
 
: ❑&nbsp;&nbsp;Usual dose: 3–5 μg/kg/min


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: ❑&nbsp;&nbsp;Maximum dose: 10 μg/kg/min</div>}}
{{Family tree|boxstyle=text-align: left; font-size: 90%; padding: 0px;| | | | |!| | | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 90%; padding: 0px;| | | | |!| | | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 90%; padding: 0px;| | | | A09 | | | | | | | | |A09=<div style="text-align: center; background: #FEDAEC; color: #000000; padding: 5px; font-weight: bold;"><BIG>'''Acute coronary syndrome likely?'''</BIG><BR>''[[{{PAGENAME}}#Criteria for Acute Myocardial Infarction|<span style="color: #000000;">(click for details on criteria)</span>]]''</div>}}
{{Family tree|boxstyle=text-align: left; font-size: 90%; padding: 0px;| | | | A09 | | | | | | | | |A09=<div style="text-align: center; background: #FEDAEC; color: #000000; padding: 5px; font-weight: bold;"><BIG>'''Acute coronary syndrome likely?'''</BIG><BR>''[[{{PAGENAME}}#Criteria for Acute Myocardial Infarction|<span style="color: #000000;">(click for details on criteria)</span>]]''</div>}}
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* Dosage and Administration<ref name="isbn1616690003">{{cite book | author = | authorlink = | editor = | others = | title = Handbook of Emergency Cardiovascular Care for Healthcare Providers | edition = | language = | publisher = | location = | year = | origyear = | pages = | quote = | isbn = 1616690003 | oclc = | doi = | url = | accessdate = }}</ref><ref name="-2000">{{Cite journal  | title = Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Part 7: the era of reperfusion: section 1: acute coronary syndromes (acute myocardial infarction). The American Heart Association in collaboration with the International Liaison Committee on Resuscitation. | journal = Circulation | volume = 102 | issue = 8 Suppl | pages = I172-203 | month = Aug | year = 2000 | doi =  | PMID = 10966673 }}</ref><ref name="NOREPINEPHRINE BITARTRATE INJECTION">{{Cite web  | last =  | first =  | title = NOREPINEPHRINE BITARTRATE INJECTION | url = http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=3352c7d0-e621-46ed-9a54-e4a9583cde10 | publisher =  | date =  | accessdate = }}</ref>
* Dosage and Administration<ref name="isbn1616690003">{{cite book | author = | authorlink = | editor = | others = | title = Handbook of Emergency Cardiovascular Care for Healthcare Providers | edition = | language = | publisher = | location = | year = | origyear = | pages = | quote = | isbn = 1616690003 | oclc = | doi = | url = | accessdate = }}</ref><ref name="-2000">{{Cite journal  | title = Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Part 7: the era of reperfusion: section 1: acute coronary syndromes (acute myocardial infarction). The American Heart Association in collaboration with the International Liaison Committee on Resuscitation. | journal = Circulation | volume = 102 | issue = 8 Suppl | pages = I172-203 | month = Aug | year = 2000 | doi =  | PMID = 10966673 }}</ref><ref name="NOREPINEPHRINE BITARTRATE INJECTION">{{Cite web  | last =  | first =  | title = NOREPINEPHRINE BITARTRATE INJECTION | url = http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=3352c7d0-e621-46ed-9a54-e4a9583cde10 | publisher =  | date =  | accessdate = }}</ref>
:* Suggested Dilution:
:* Mix 1 ampule (4 mg) of [[norepinephrine]] in 250 mL of [[Intravenous sugar solution|D5W]] or [[Intravenous sugar solution|D5NS]]. Avoid dilution in [[normal saline]] alone.
::* Mix 4 mg of [[norepinephrine]] in 250 mL of [[Intravenous sugar solution|D5W]] or [[Intravenous sugar solution|D5NS]]. Avoid dilution in [[normal saline]] alone.
:* Initial dose: 0.5–1.0 μg/min [[IV|IV infusion]]; titrate to maintain [[SBP]] at above 90 mm Hg (up to 30–40 μg/min).
:* Suggested Regimen:
::* Start at a dose of 0.5–1.0 μg/min [[IV|IV infusion]]; titrate to maintain [[SBP]] at above 90 mm Hg (up to 30–40 μg/min).
<!--
<!--
* Indications
* Indications
Line 349: Line 351:
::* The rate of infusion needed to increase cardiac output usually ranged from 2.5 to 15 mcg/kg/min.
::* The rate of infusion needed to increase cardiac output usually ranged from 2.5 to 15 mcg/kg/min.
::* On rare occasions, infusion rates up to 40 mcg/kg/min have been required to obtain the desired effect.
::* On rare occasions, infusion rates up to 40 mcg/kg/min have been required to obtain the desired effect.
* Contraindications
* Contraindications:
:* Idiopathic hypertrophic subaortic stenosis
:* Idiopathic hypertrophic subaortic stenosis
:* Hypersensitivity to dobutamine
:* Hypersensitivity to dobutamine
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<div class="mw-collapsible-content">


* Dosage and Administration<ref name="isbn1616690003">{{cite book | author = | authorlink = | editor = | others = | title = Handbook of Emergency Cardiovascular Care for Healthcare Providers | edition = | language = | publisher = | location = | year = | origyear = | pages = | quote = | isbn = 1616690003 | oclc = | doi = | url = | accessdate = }}</ref><ref name="-2000">{{Cite journal  | title = Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Part 7: the era of reperfusion: section 1: acute coronary syndromes (acute myocardial infarction). The American Heart Association in collaboration with the International Liaison Committee on Resuscitation. | journal = Circulation | volume = 102 | issue = 8 Suppl | pages = I172-203 | month = Aug | year = 2000 | doi =  | PMID = 10966673 }}</ref><ref name="NITROGLYCERIN INJECTION, SOLUTION">{{Cite web  | last =  | first =  | title = NITROGLYCERIN INJECTION, SOLUTION [AMERICAN REGENT, INC.] | url = http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=8c52cdf6-87be-4719-b105-f08be096d462 | publisher =  | date =  | accessdate = }}</ref>
* Dosage and Administration<ref name="isbn1616690003">{{cite book | author = | authorlink = | editor = | others = | title = Handbook of Emergency Cardiovascular Care for Healthcare Providers | edition = | language = | publisher = | location = | year = | origyear = | pages = | quote = | isbn = 1616690003 | oclc = | doi = | url = | accessdate = }}</ref><ref name="-2000">{{Cite journal  | title = Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Part 7: the era of reperfusion: section 1: acute coronary syndromes (acute myocardial infarction). The American Heart Association in collaboration with the International Liaison Committee on Resuscitation. | journal = Circulation | volume = 102 | issue = 8 Suppl | pages = I172-203 | month = Aug | year = 2000 | doi =  | PMID = 10966673 }}</ref>
:* Suggested Initial Dilution:
 
::* Nitroglycerin must be diluted in dextrose (5%) injection or sodium chloride (0.9%) injection prior to its infusion. Transfer 50 mg of nitroglycerin into a 500 mL glass bottle of either dextrose (5%) injection or sodium chloride injection (0.9%). This yields a final concentration of 100 μg/mL. Diluting 5 mg nitroglycerin into 100 mL will yield a final concentration of 50 μg/mL.
 
:* Suggested Maintenance Dilution:
:*
::* Consider the fluid requirements of the patient as well as the expected duration of infusion in selecting the appropriate dilution of Nitroglycerin Injection.
::* The concentration of nitroglycerin should not exceed 400 μg/mL.
:* Suggested Regimen:
::* The initial dosage should be 5 μg/min delivered through an infusion pump. Subsequent titration must be adjusted to the clinical situation, with dose increments becoming more cautious as partial response is seen.
::* Initial titration should be in 5 μg/min increments, with increases every 3–5 minutes until some response is noted.
::* If no response is seen at 20 μg/min, increments of 10 and later 20 μg/min can be used.
::* Once a partial blood pressure response is observed, the dose increase should be reduced and the interval between increases should be lengthened.
* Contraindications
* Contraindications
:* Pericardial tamponade
:*  
:* Restrictive cardiomyopathy
:* Constrictive pericarditis
:* Hypersensitivity to nitroglycerin
</div></div>
</div></div>



Revision as of 03:35, 5 May 2014

Cardiogenic Shock
Resident Survival Guide
Overview
Causes
FIRE
Emergency Revascularization
Diagnostic Criteria
Blood Pressure Maintenance
Hemodynamic Optimization
Complete Diagnostic Approach
Do's
Don'ts

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

FIRE: Focused Initial Rapid Evaluation

A Focused Initial Rapid Evaluation (FIRE) should be performed to identify patients in need of immediate intervention.[1]

Boxes in red signify that an urgent management is needed.

Abbreviations: CBC, complete blood count; CI, cardiac index; CK-MB, creatine kinase MB isoform; CVP, central venous pressure; DC, differential count; ICU, intensive care unit; INR, international normalized ratio; LFT, liver function test; MAP, mean arterial pressure; PCWP, pulmonary capillary wedge pressure; PT, prothrombin time; PTT, partial prothrombin time; SaO2, arterial oxygen saturation; SBP, systolic blood pressure; ScvO2, central venous oxygen saturation; SvO2, mixed venous oxygen saturation; SMA-7, sequential multiple analysis-7.

 
 
 
 
 
 
 
Does the patient have cardinal findings that increase the pretest probability of cardiogenic shock?

❑  Evidence of end-organ hypoperfusion

❑  Altered mental status
❑  Cold extremities
❑  Cyanosis
❑  Oliguria (urine output <0.5 mL/kg/h)
❑  Sustained hypotension (≥30 min)
❑  SBP <90 mm Hg or
❑  MAP ↓ >30 mm Hg below baseline
❑  Presence of myocardial dysfunction after exclusion or correction of non-myocardial factors contributing to tissue hypoperfusion
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
YES
 
 
 
 
 
NO
 
 
 
Cardiogenic shock suspected
(click for details on criteria)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Immediate steps
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Initial workup

❑  Arterial blood gas

❑  CBC/DC/SMA-7/LFT/PT/PTT/INR

❑  Cardiac troponins, CK-MB

❑  BNP, NT-proBNP

❑  Lactate

❑  12-Lead ECG

❑  Chest radiograph

❑  Echocardiography
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Maintain adequate blood pressure
(click for details)
 
 
 
 
 
 
 
 
 
 
 

SBP <70 mm Hg:

❑  Norepinephrine IV infusion

❑  Initial dose: 0.5–1.0 μg/min
❑  Maximum dose: 30–40 μg/min
❑  Titrate to SBP >90 mm Hg

SBP 70–100 mm Hg with symptoms:

❑  Dopamine IV infusion

❑  Cardiac dose: 5–10 μg/kg/min
❑  Vasopressor dose: >10 μg/kg/min
❑  Maximum dose: 20–50 μg/kg/min

SBP 70–100 mm Hg w/o symptoms:

❑  Dobutamine IV infusion

❑  Usual dose: 2–20 μg/kg/min
❑  Maximum dose: 40 μg/kg/min
❑  Avoid ↑ HR by >10% of baseline

SBP >100 mm Hg:

❑  Nitroglycerin IV infusion

❑  Initial dose: 5 μg/min
❑  Usual dose: 10–20 μg/min

❑  Nitroprusside IV infusion

❑  Initial dose: 0.3 μg/kg/min
❑  Usual dose: 3–5 μg/kg/min
❑  Maximum dose: 10 μg/kg/min
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Acute coronary syndrome likely?
(click for details on criteria)
 
 
 
 
 
 
 
 
 
 
 
❑  New ECG changes suggestive of AMI

❑  ± Positive cTnT, cTnI, or CK-MB

❑  ± Symptoms of myocaridal ischemia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
YES
 
 
 
 
NO
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Optimize hemodynamic status
(click for details)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Preload

Goal: PCWP 15–18 mm Hg, CVP 8–12 cm H2O

❑  Fluid challenge protocol ("TROL")

❑  ± Correct pulmonary congestion

❑  ± Furosemide 40 mg slow IV injection
❑  ± Morphine 2–4 mg slow IV injection
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Afterload

Goal: MAP >65 mm Hg, SVR 800–1200 dyn·s·cm−5

❑  If ↑ MAP & ↑ SVR: wean vasopressors ± vasodilators

❑  If ↓ MAP & ↑ SVR: vasopressors + inotropes

❑  If ↓ MAP & ↓ SVR: vasopressors ± vasopressin

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Cardiac index

Goal: CI >2.2 L/min/m2

❑  ± Dobutamine

❑  ± Milrinone
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Evaluate perfusion and oxygenation
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Endpoints:

❑  SaO2 >92%

❑  SvO2 >60%

❑  ScvO2 >70%

❑  Urine output >0.5 mL/kg/h

❑  Lactate <2.2 mM/L

❑  Hematocrit ≥30%
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
If hypoperfusion persists:
❑  Consider IABP, VAD, or ECMO if indicated
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Emergency Revascularization [Return to FIRE]

Diagnostic Criteria [Return to FIRE]

Criteria for Cardiogenic Shock

Criteria for Acute Myocardial Infarction

  • Detection of a rise and/or fall of cardiac biomarker values (preferably cardiac troponin) with at least one value above the 99th percentile upper reference limit and with at least one of the following:[8]
  • Recent episode of typical ischemic discomfort that either is of new onset or is severe or that exhibits an accelerating pattern of previous stable angina (especially if it has occurred at rest or is within 2 weeks of a previously documented MI)
  • Chest pain or severe epigastric pain, nontraumatic in origin, with components typical of myocardial ischemia or MI:
  • Central/substernal compression or crushing chest pain
  • Pressure, tightness, heaviness, cramping, burning, aching sensation
  • Unexplained indigestion, belching, epigastric pain
  • Radiating pain in neck, jaw, shoulders, back, or 1 or both arms

Maintenance of Blood Pressure [Return to FIRE]

Norepinephrine

  • Contraindications

Dopamine

  • Suggested Dilution: transfer contents of one or more ampuls or vials by aseptic technique to either 250 mL or 500 mL of one of the following sterile intravenous solutions
  • Sodium Chloride Injection
  • Dextrose (5%) Injection
  • Dextrose (5%) and Sodium Chloride (0.9%) Injection
  • 5% Dextrose in 0.45% Sodium Chloride Solution
  • Dextrose (5%) in Lactated Ringer’s Solution
  • Sodium Lactate (1/6 Molar) Injection
  • Lactated Ringer’s Injection
  • Suggested Regimen:
  • Begin administration of diluted solution at doses of 2–5 μg/kg/minute in patients who are likely to respond to modest increments of heart force and renal perfusion.
  • In more seriously ill patients, begin administration of diluted solution at doses of 5 μg/kg/minute and increase gradually, using 5–10 μg/kg/minute increments, up to 20–50 μg/kg/minute as needed.
  • If doses of 50 μg/kg/minute are required, it is suggested that urine output be checked frequently. Should the urine flow begin to decrease in the absence of hypotension, reduction of dosage should be considered.
  • Treatment of all patients requires constant evaluation of therapy in terms of the blood volume, augmentation of myocardial contractility, and distribution of peripheral perfusion. Dosage should be adjusted according to the patient’s response, with particular attention to diminution of established urine flow rate, increasing tachycardia or development of new dysrhythmias as indices for decreasing or temporarily suspending the dosage.
  • Contraindications
  • Pheochromocytoma
  • Uncorrected tachyarrhythmias or ventricular fibrillation

Dobutamine

  • Suggested Dilution: dobutamine injection must be further diluted in an IV container. Dilute 20 mL of dobutamine in at least 50 mL of diluent and dilute 40 mL of dobutamine in at least 100 mL of diluent. Use one of the following intravenous solutions as a diluent:
  • Dextrose Injection 5%
  • Dextrose 5% and Sodium Chloride 0.45% Injection
  • Dextrose 5% and Sodium Chloride 0.9% Injection
  • Dextrose Injection 10%, Isolyte® M with 5% Dextrose Injection
  • Lactated Ringer’s Injection
  • 5% Dextrose in Lactated Ringer’s Injection
  • Normosol®-M in D5-W
  • 20% Osmitrol® in Water for Injection
  • Sodium Chloride Injection 0.9%
  • Sodium Lactate Injection
  • Suggested Regimen:
  • The rate of infusion needed to increase cardiac output usually ranged from 2.5 to 15 mcg/kg/min.
  • On rare occasions, infusion rates up to 40 mcg/kg/min have been required to obtain the desired effect.
  • Contraindications:
  • Idiopathic hypertrophic subaortic stenosis
  • Hypersensitivity to dobutamine

Nitroglycerin


  • Contraindications

Nitroprusside


  • Contraindications

Optimization of Hemodynamic Status [Return to FIRE]

Preload

Fluid Challenge Protocol
  • Protocolized fluid administration titrated to hemodynamic and clinical endpoints secures the efficacy of tissue perfusion and oxygenation.[15]
  • Four elements of the fluid challenge protocol: type of fluid (T), rate of fluid administration (R), objective (O), and limits (L).[16]
  • 1. Type of fluid (T)
  • The choice of crystalloid or colloid solution should be made on the basis of the underlying disease, the nature of fluid deficit, the severity of circulatory failure, the serum albumin concentration, and the risk of bleeding.[17]
  • There were no significant differences in mortality between saline and albumin infusion for critically ill patients.[18]
  • Blood transfusion may be considered in the presence of profound anemia or massive hemorrhage.[15]
  • Hyperchloremic acidosis may be associated with the use of isotonic saline solution.[19]
  • 2. Rate of fluid administration (R)
Baseline PCWP (mm Hg) Baseline CVP (cm H2O) Rate of fluid administration
≥16 ≥14 50 mL over 10 minutes
<16 but ≥12 <14 but ≥8 100 mL over 10 minutes
<12 <8 200 mL over 10 minutes
  • 3. Objective (O)
  • Fluid administration should be titrated to reach predetermined clinical endpoints such as resolution of tachycardia or oliguria, improved skin perfusion or level of consciousness, normalization of lactate concentrations, and restoration of adequate blood pressure or ventricular filling pressure.[17]
  • 4. Limits (L)
  • Fluid administration should be stopped if the safety limits are violated to minimize the risk of developing pulmonary edema.
  • Inotropes, vasodilators, or mechanical circulatory device may be required if signs of hypoperfusion persist despite optimal fluid loading.
  • Hemodynamic safety limits based on PCWP (the 7–3 rule) or CVP (the 5–2 rule):[15]
↑ PCWP (mm Hg) ↑ CVP (cm H2O) Action
≥7 ≥5 Stop fluid administration
<7 but >3 <5 but >2 Wait and recheck pressure after 10 minutes
≤3 ≤2 Continue fluid administration
Pulmonary Congestion
  • Findings suggestive of cardiogenic pulmonary edema:[20]
  • History and clinical manifestations
  • Cough
  • Dyspnea
  • Expectoration of frothy sputum
  • Orthopnea
  • Paroxysmal nocturnal dyspnea
  • Signs and symptoms of heart failure
  • Signs and symptoms of hypoxemia
  • Signs and symptoms of myocardial ischemia
  • Signs and symptoms of valvular dysfunction
  • Tachypnea
  • Physical examination
  • Cool extremities
  • Heart murmurs
  • Hepatomegaly
  • Inspiratory crackles or rhonchi
  • Jugular venous distention
  • S3 gallop
  • Peripheral edema
  • Laboratory and hemodynamic findings
  • BNP > 500 pg/mL
  • PCWP >18 mm Hg
  • Radiologic findings
  • Central infiltrates with peripheral sparing
  • Cephalization of pulmonary vessels
  • Enlarged cardiac silhouette
  • Enlargement of peribronchovascular spaces
  • Increased opacity of acinar areas that coalesce into frank consolidations
  • Kerley B lines
  • Peribronchial cuffing
  • Pleural effusions
  • Vascular pedicle width >70 mm
PCWP (mm Hg) Phase of Pulmonary Congestion Findings on Chest Radiograph
18–20 Onset of pulmonary congestion Redistribution of pulmonary flow to the upper lobes ("cephalization") and Kerley lines
20–25 Moderate congestion Diminished clarity of the borders of medium-sized pulmonary vessels ("perihilar haze")
25–30 Severe congestion Radiolucent grapelike clusters surrounded by radiodense fluid ("periacinar rosette")
>30 Onset of pulmonary edema Coalescence of periacinar rosettes resulting in "Bat's wing" opacities
  • Dosage and Administration
  • For acute pulmonary edema, the initial dose is 40 mg injected slowly intravenously (over 1 to 2 minutes).
  • If a satisfactory response does not occur within 1 hour, the dose may be increased to 80 mg injected slowly intravenously (over 1 to 2 minutes).
  • Contraindications
  • Dosage and Administration
  • Morphine may be used adjunctively in the treatment of acute pulmonary edema at a dose of 2–4 mg (slow IV injection over 1–5 minutes) every 5–30 minutes as needed.
  • Contraindications

Afterload

content here

Cardiac Index


Complete Diagnostic Approach

Do's

Don'ts

References

  1. Robin, E.; Costecalde, M.; Lebuffe, G.; Vallet, B. (2006). "Clinical relevance of data from the pulmonary artery catheter". Crit Care. 10 Suppl 3: S3. doi:10.1186/cc4830. PMID 17164015.
  2. 2.0 2.1 Califf, RM.; Bengtson, JR. (1994). "Cardiogenic shock". N Engl J Med. 330 (24): 1724–30. doi:10.1056/NEJM199406163302406. PMID 8190135. Unknown parameter |month= ignored (help)
  3. Hollenberg, SM.; Kavinsky, CJ.; Parrillo, JE. (1999). "Cardiogenic shock". Ann Intern Med. 131 (1): 47–59. PMID 10391815. Unknown parameter |month= ignored (help)
  4. 4.0 4.1 Goldberg, RJ.; Gore, JM.; Alpert, JS.; Osganian, V.; de Groot, J.; Bade, J.; Chen, Z.; Frid, D.; Dalen, JE. (1991). "Cardiogenic shock after acute myocardial infarction. Incidence and mortality from a community-wide perspective, 1975 to 1988". N Engl J Med. 325 (16): 1117–22. doi:10.1056/NEJM199110173251601. PMID 1891019. Unknown parameter |month= ignored (help)
  5. 5.0 5.1 5.2 Forrester, JS.; Diamond, G.; Chatterjee, K.; Swan, HJ. (1976). "Medical therapy of acute myocardial infarction by application of hemodynamic subsets (first of two parts)". N Engl J Med. 295 (24): 1356–62. doi:10.1056/NEJM197612092952406. PMID 790191. Unknown parameter |month= ignored (help)
  6. 6.0 6.1 Forrester, JS.; Diamond, G.; Chatterjee, K.; Swan, HJ. (1976). "Medical therapy of acute myocardial infarction by application of hemodynamic subsets (second of two parts)". N Engl J Med. 295 (25): 1404–13. doi:10.1056/NEJM197612162952505. PMID 790194. Unknown parameter |month= ignored (help)
  7. 7.0 7.1 Reynolds, HR.; Hochman, JS. (2008). "Cardiogenic shock: current concepts and improving outcomes". Circulation. 117 (5): 686–97. doi:10.1161/CIRCULATIONAHA.106.613596. PMID 18250279. Unknown parameter |month= ignored (help)
  8. Thygesen, K.; Alpert, JS.; Jaffe, AS.; Simoons, ML.; Chaitman, BR.; White, HD.; Thygesen, K.; Alpert, JS.; White, HD. (2012). "Third universal definition of myocardial infarction". J Am Coll Cardiol. 60 (16): 1581–98. doi:10.1016/j.jacc.2012.08.001. PMID 22958960. Unknown parameter |month= ignored (help)
  9. 9.0 9.1 9.2 9.3 9.4 9.5 9.6 Handbook of Emergency Cardiovascular Care for Healthcare Providers. ISBN 1616690003.
  10. 10.0 10.1 10.2 10.3 10.4 "Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Part 7: the era of reperfusion: section 1: acute coronary syndromes (acute myocardial infarction). The American Heart Association in collaboration with the International Liaison Committee on Resuscitation". Circulation. 102 (8 Suppl): I172–203. 2000. PMID 10966673. Unknown parameter |month= ignored (help)
  11. "NOREPINEPHRINE BITARTRATE INJECTION".
  12. "DOPAMINE HCL INJECTION, SOLUTION [AMERICAN REGENT, INC.]".
  13. "DOBUTAMINE (DOBUTAMINE HYDROCHLORIDE) INJECTION, SOLUTION [HOSPIRA, INC.]".
  14. Crexells, C.; Chatterjee, K.; Forrester, JS.; Dikshit, K.; Swan, HJ. (1973). "Optimal level of filling pressure in the left side of the heart in acute myocardial infarction". N Engl J Med. 289 (24): 1263–6. doi:10.1056/NEJM197312132892401. PMID 4749545. Unknown parameter |month= ignored (help)
  15. 15.0 15.1 15.2 15.3 Weil, MH.; Henning, RJ. "New concepts in the diagnosis and fluid treatment of circulatory shock. Thirteenth annual Becton, Dickinson and Company Oscar Schwidetsky Memorial Lecture". Anesth Analg. 58 (2): 124–32. PMID 571235.
  16. Vincent, JL. (2011). "Let's give some fluid and see what happens versus the mini-fluid challenge". Anesthesiology. 115 (3): 455–6. doi:10.1097/ALN.0b013e318229a521. PMID 21792055. Unknown parameter |month= ignored (help)
  17. 17.0 17.1 Vincent, JL.; Weil, MH. (2006). "Fluid challenge revisited". Crit Care Med. 34 (5): 1333–7. doi:10.1097/01.CCM.0000214677.76535.A5. PMID 16557164. Unknown parameter |month= ignored (help)
  18. Finfer, S.; Bellomo, R.; Boyce, N.; French, J.; Myburgh, J.; Norton, R. (2004). "A comparison of albumin and saline for fluid resuscitation in the intensive care unit". N Engl J Med. 350 (22): 2247–56. doi:10.1056/NEJMoa040232. PMID 15163774. Unknown parameter |month= ignored (help)
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