Inadequate Perfusion - Cardiogenic Causes

Inadequate Perfusion: Cardiogenic Causes (Adult)

Stop

Manage other causes, e.g. arrhythmia, pain, hypovolaemia


Assess for signs of pulmonary oedema (crackles)


Crackles			No Crackles
Adrenaline infusion as per Inadequate or Extremely Poor Perfusion (below)			Normal Saline 250ml IV - Repeat 250ml IV if chest clear and Inadequate or Extremely Poor Perfusion persists

Inadequate or Extremely Poor Perfusion persists

Adrenaline infusion (3mg/50ml Dextrose 5%/Normal Saline) commencing at 5mcg/minute (5ml/hr)
- Increase by 5mcg/minute, 2 minutely until adequate perfusion or side effects
- If poor perfusion persists, reassess Pt and delivery system prior to increasing rate beyond 50mcg/minute
- If syringe pump unavailable/malfunction:
  - Adrenaline 10mcg IV
  - repeat 10mcg, 2 minutely until adequate perfusion/side effects
  - If poor response
  - Adrenaline 50-100mcg IV as required
  - NB. Doses >100mcg may be required

If chest clear continue Normal Saline 250ml IV boluses up to 20ml/kg

Special Notes

Any intravenous infusions established under this Guideline must be clearly labelled with the name and dose of any additive drugs and their dilution.

A Pt presenting with inadequate to extremely poor perfusion resulting from a cardiac event may not always have associated chest pain, e.g. silent myocardial infarction, cardiomyopathy.

Pts presenting with suspected pulmonary embolus with inadequate to extremely poor perfusion should be managed with this Guideline. Pulmonary embolus is not specifically a cardiac problem but may lead to cardiogenic shock due to an obstruction to venous return and the Pt may require fluid and Adrenaline therapy

General Care

Adrenaline infusion >50mcg/minute may be required to manage these Pts.
- Ensure delivery system is fully operational (e.g. tube not kinked, IV patent) prior to increasing dose.

Unstable Pts may require bolus Adrenaline concurrently with the infusion.

Adrenaline infusion - 3mg Adrenaline added to make 50ml with Dextrose 5% or Normal Saline.
- 1ml/hr = 1mcg/min