Pumpless Paul — Cardiogenic Shock
Pump fails: cold, clammy, crackles, high filling pressures
Paul's pump loses half its muscle in a single morning. The tank is full but nothing circulates — his lungs fill from behind while his fingertips go grey.
Paul's heart cannot move the blood it already has. After a large anterior MI he is cold, clammy and hypotensive with crackles and jugular vein distention. Fluids drown him; he needs inotropes, afterload reduction and reperfusion.
Read Pumpless Paul's full story →The story arc
The setup
An anterior STEMI is treated late; a large section of left ventricle stops contracting.
The turn
His skin turns cool and mottled, his pulses thread out, and he cannot lie flat without gasping.
The crisis
Blood pressure 78/50, crackles to the scapulae, jugular veins distended, urine output 10 mL/hr.
The save
Dobutamine improves contractility, careful diuresis unloads the lungs, and he goes to the cath lab for revascularization.
NCLEX study section — Cardiogenic Shock
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Cardiovascular
Take this chapter into practice questions on the same topic.