رجل عمره ٦٦ سنة في اليوم الأول بعد احتشاء أمامي واسع، صار مشوشاً. الضغط ٧٨/٥٠، النبض ١١٨، التنفس ٢٨، التشبع ٨٨٪. أطرافه باردة ومبقعة، وبوله ١٥ مل/ساعة، والخراخر منتشرة في الرئتين. أي تفسير يناسب حالته؟

A 66-year-old man on day 1 after a large anterior MI becomes confused. BP 78/50, HR 118, RR 28, SpO2 88%. His limbs are cold and mottled, urine output is 15 mL/h and crackles are widespread. Which interpretation fits his condition?

1. Anaphylactic shock from the catheterisation contrast
2. Hypovolaemic shock from dehydration and sweating
3. Septic shock from a post-procedure infection
4. Cardiogenic shock from left ventricular pump failure

Answer: D) Cardiogenic shock from left ventricular pump failure. A large anterior MI with hypotension, poor perfusion, oliguria and pulmonary congestion is cardiogenic shock. Hypovolaemia gives clear lungs, and early septic shock usually has warm extremities.