Sandbox/00008

FIRE: Focused Initial Rapid Evaluation

A Focused Initial Rapid Evaluation (FIRE) should be performed to identify patients in need of immediate intervention.

Boxes in the salmon color signify that an urgent management is needed.

Abbreviations: CBC, complete blood count; CI, cardiac index; CK-MB, creatine kinase MB isoform; CVP, central venous pressure; DC, differential count; ICU, intensive care unit; INR, international normalized ratio; LFT, liver function test; MAP, mean arterial pressure; MVO2, mixed venous oxygen saturation; PCWP, pulmonary capillary wedge pressure; PT, prothrombin time; PTT, partial prothrombin time; SaO2, arterial oxygen saturation; SBP, systolic blood pressure; SCVO2, central venous oxygen saturation; SMA-7, sequential multiple analysis-7.

Does the patient have cardinal findings that increase the pretest probability of cardiogenic shock? ❑  Sustained hypotension ❑  SBP <90 mm Hg for ≥30 min or ❑  MAP ↓ >30 mm Hg below baseline for ≥30 min ❑  Evidence of hypoperfusion ❑  Altered mental status ❑  Cool extremities ❑  Cyanosis ❑  Oliguria ❑  Presence of myocardial dysfunction ❑  Exclusion or correction of non-myocardial factors contributing to tissue hypoperfusion ❑  Hypovolemia ❑  Hypoxia ❑  Acidosis

YES

NO

Cardiogenic shock suspected

Consider other causes of shock ❑  Hypovolemic shock ❑  Obstructive shock ❑  Distributive shock

Immediate mangement ❑  Intubation with mechanical ventilation ❑  ECG monitor ❑  Pulse oximeter ❑  Arterial blood gas ❑  Central venous catheter ❑  Pulmonary artery catheter ❑  CBC/DC/SMA-7/LFT/PT/PTT/INR ❑  Troponin, CK-MB ❑  Lactate ❑  Chest radiograph ❑  Echocardiography ❑  Foley catheter ❑  ICU admission