Without the use of the swan, what is the best indicator a patient is in cardiogenic shock vs sepsis. I was told past medical history but a patient may have a significant past cardiac medical history and still be septic. Help me understand please.
So without the use of a swan...an Echo is a great tool...cardiogenic shock often shows global hypokinesis, elevated filling pressures, wall motion abnormalities, and a dramatically reduced estimated EF. This often correlates to a picture of a cold shock/low flow/perfusion state. I find that often these patients are either orthopnic/tachypnic/hypoxic and agitated or very very quiet, cold, and obtunded.
The septic patients on echo sometimes have a hyperdynamic LV, flat IVC, etc. Their clinical picture correlates with infection, positive cultures, fluid/vasopressor responsive distributive shock.
Yes definitely we get patients all the time that have both septic and cardiogenic shock (eg: really really sick endocarditis patients). These patients are often very tricky to get their fluid/volume status correct.
The "best" indicator? Besides the history and physical? There is no "best" single indicator. It's a medical diagnosis that comes from an assessment and lab work. If you need a PA catheter or an echo to tell the difference between the two, you're probably not a diagnostician.
Just google sepsis criteria or diagnosis and you'll see what I mean.
Cardiogenic shock is a sudden pump failure. Septic shock is caused by a cascade of events that start with an infection. Just because a patient has a cardiac history doesn't mean that they'll go into cardiogenic shock over a different kind of shock. Two different disease processes. If a patient has both going on, I doubt there would be time to sit and ponder the differences!
Labs. Elevated Lactate, procal, elevated CRP, WBC would indicate sepsis.
For cardiogenic shock: troponin, myoglobin, Pro-BNP. ECG changes and of course, typical s/s of pump failure; wet lungs, swollen legs , heart gallop (s3 OR s4).
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