Josh and Adam discuss cardiogenic shock and severe heart failure, focusing on patient evaluation, risk stratification, and treatment. They cover assessing cardiac index, pulmonary capillary wedge pressure, and total body volume status, integrating these into the Forrester classification to determine if a patient is warm/cold and wet/dry. The discussion includes treating the lungs with BiPAP or thoracentesis, optimizing blood pressure through afterload reduction or vasopressors, and managing volume status with diuretics or, in rare cases, fluid administration. They address inotropes as a last resort for hypoperfusion and emphasize investigating and treating the underlying causes of heart failure, while also cautioning against nephrotoxic medications, suppressing sinus tachycardia, and applying outpatient management strategies to critically ill patients.
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