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.