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Save this for your next cardiogenic shock and Impella patient. Simple approach to Impella/alarms, physiologic assessment of cardiogenic shock severity, and escalation criteria are reviewed here. And if you remember nothing else, remember that you can still have hypoperfusion despite a MAP of 65 and an Impella flow rate of 3.5L/min. If you want me to clarify anything, please comment below. What would you escalate him to? #icu #cardiology #residency #meded #icunurse