R57.0
DESCRIPTION
Patients are hypotensive, cold and clammy and their pulse rate may be variable. Causes include an acute myocardial infarction, myocardial contusion, myocarditis, dysrhythmias, valvular heart disease, aortic dissecting aneurysm etc.
Consult with specialist and consider referring patients after initial emergency measures have been taken.
GENERAL MEASURES
Check circulation, airway and breathing.
ECG.
Treat the underlying cause, e.g.: MI, dysrhythmia, etc.
MEDICINE TREATMENT
- Oxygen if saturation <94%.
A right ventricular myocardial infarction may respond to a fluid challenge:
- Sodium chloride 0.9%, IV.
- Administer 250–500 mL as a bolus and assess fluid responsiveness.
- Dobutamine, infusion, 5–10 mcg/kg/minute.
- Dilute 1 vial (250 mg/20 mL) up to 50 mL with sodium chloride 0.9% or dextrose 5% (5 mg/mL or 5 000 mcg/mL).
- Rate of infusion in mL/hour:
| Dose mcg/kg/min | 30 | 40 | 50 | 60 | 70 | 80 | 90 | 100 | 110 | 120 |
|---|---|---|---|---|---|---|---|---|---|---|
| 2 | 0.9 | 1.2 | 1.5 | 1.8 | 2.1 | 2.4 | 2.7 | 3 | 3.3 | 3.6 |
| 5 | 1.8 | 2.4 | 3 | 3.6 | 4.2 | 4.8 | 5.4 | 6 | 6.6 | 7.2 |
| 7.5 | 2.7 | 3.6 | 4.5 | 5.4 | 6.3 | 7.2 | 8.1 | 9 | 9.9 | 10.8 |
| 10 | 3.6 | 4.8 | 6 | 7.2 | 8.4 | 9.6 | 10.8 | 12 | 13.2 | 14.4 |