Shock  Solution 8

Clinical Scenario 8

A 63 year old male is admitted through the ER. He presented with acute shortness of breath. On admission his BP was 90/50, heart rate 110, PaO2 80 on 100% oxygen. His ECG shows left ventricular hypertrophy with T wave across his antero-lateral leads. His chest x-ray shows cardiac hypertrophy with bilateral infiltrates. He has a history of hypertension, treated with lisinopril, and has a 40 pack-year history of smoking.

What is your diagnosis and how would you manage this patient?

This is pump failure with diastolic dysfunction. This patient has acute left ventricular failure with pulmonary edema. The treatment is oxygen, followed by preload reducing agents – furosemide or nitroglycerin. Intravenous morphine will reduce the patients suffering.

Dx: cardiogenic shock, pump failure.