What is the first step in suspected cardiogenic shock management in the ED?

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In suspected cardiogenic shock, the first priority is to stabilize the patient by securing the airway and supporting breathing, while immediately establishing circulation basics. Recognizing signs of shock and ensuring adequate oxygen delivery sets the foundation for any further treatment. Establishing IV access and placing the patient on continuous monitoring allow rapid support with medications if needed and continuous assessment of perfusion and rhythm. This approach also enables prompt preparation for vasopressors or inotropes to support blood pressure and for revascularization to treat the underlying cause, typically myocardial ischemia. Jumping straight to high-dose vasopressors, invasive hemodynamic monitoring for all patients, or initiating thrombolysis before stabilization can worsen outcomes or cause delays; stabilization first ensures therapies are safe and effective.