NREMT Paramedic Cognitive ExamCardiology & ResuscitationHard
A 40-year-old female is experiencing chest pain, diaphoresis, and shortness of breath. Her blood pressure is 70/40 mmHg, heart rate 130 bpm, and lung sounds reveal bilateral crackles. Her ECG shows ST elevation in multiple leads. What type of shock is MOST likely occurring?
- ACardiogenic shock
- BObstructive shock
- CHypovolemic shock
- DDistributive shock
Show answer & explanationAnswer & explanation
Correct answer: A. Cardiogenic shock
The patient's presentation of chest pain, ST elevation (indicating myocardial infarction), severe hypotension, tachycardia, and pulmonary edema (bilateral crackles) is a classic picture of cardiogenic shock. This occurs when the heart's pumping function is severely impaired, leading to inadequate tissue perfusion despite adequate intravascular volume.
Why the other options are wrong
- B. Obstructive shock would involve a physical obstruction, and while MI can lead to mechanical complications, the primary issue described is pump failure.
- C. Hypovolemic shock would not typically have bilateral crackles (pulmonary edema) as a primary feature.
- D. Distributive shock often presents with vasodilation and warm, flushed skin initially, and the underlying cause (e.g., MI) is more indicative of cardiogenic shock.
Cardiogenic Shock Presentation
Cardiogenic shock is a state of severe heart pump failure, often due to acute myocardial infarction, characterized by persistent hypotension, signs of tissue hypoperfusion, and signs of pulmonary congestion (e.g., crackles).
- Caused by severe pump dysfunction (e.g., large MI, severe heart failure exacerbation).
- Hallmark signs: hypotension (SBP < 90 mmHg), signs of hypoperfusion (AMS, cool skin, oliguria), and pulmonary edema (crackles, dyspnea).
- Treatment focuses on improving cardiac output and maintaining perfusion while treating the underlying cause.
Memory trick: H.O.C.D. - Hypo, Obstructive, Cardio, Distributive