hi every one 

i want to ask questions regarding shock therapy in cardiogenic shock ..

i know its beyond the scope of this forum , but iam looking for an expert answer (practical not theoritical)

during my cardiology rotation. ive seen a lot of cases in late neonatal peroid or , more commonly early infancy, knowing or suscpected to have cardiological problem coming in compensated shock phase (tachycardic' poor perfusion , normal bl.p 

weak pulses , sweating and cold extr) , when i examined the liver, frequently i found it enlarged.

some has adviced me to give lasix then fluid 10cc /kg .and here i want to ask whats the best approach in this situation .??

aggressive fluid may overload the weak heart and lasix my cause hypotention (the last desired thing )

iam confused ..

any helpfull inf

It depend on the cause of cardiogenic shock

In a term baby coming in shock it's always helpful to think about the three most important differential diagnoses:

1- Sepsis

2- Cardiac

3- Metabolic

you have to resuscitate with volume expansion and inotropic  support. Investigate and cover with broad spectrum antibiotics. Do metabolic blood work. If you think this is cardiac( duct dependant systemic circulation as in coarctation and hypo plastic left heart syndrome then you have to start prostaglandin infusion.

heart failure due to SVT or myocarditis is also possible and should be kept in mind. 

I wouldn't start any Lasix on a baby presenting with shock unless I already know this patient is known to have some sort of complex heart disease and is presenting with lung congestion, tachycardia and tachypnea.

my advice is to stick to the principles of resuscitation and cover all possible diagnoses.

thanks

Omer Hamud, MD, FRCPC