Emergency Medical Minute29 Touko 2023

Podcast 853: Critical Care Medications - Vasopressors

Contributor: Travis Barlock MD

Educational Pearls:

Three categories of pressors: inopressors, pure vasoconstrictors, and inodilators
Inopressors:

Epinephrine - nonselective beta- and alpha-adrenergic agonism, leading to increased cardiac contractility, chronotropy (increased heart rate), and peripheral vasoconstriction. Dose 0.1mcg/kg/min.
Levophed (norepinephrine) - more vasoconstriction peripherally than inotropy; useful in most cases of shock. Dose 0.1mcg/kg/min.

Peripheral vasoconstrictors:

Phenylephrine - pure alpha agonist; useful in atrial fibrillation because it avoids cardiac beta receptor activation and also in post-intubation hypotension to counteract the RSI medications. Start at 1mcg/kg/min and increase as needed.
Vasopressin - No effect on cardiac contractility. Fixed dose of 0.4 units/min.

Inodilators are useful in cardiogenic shock but often not started in the ED since patients mostly have undifferentiated shock

Dobutamine - start at 2.5mcg/kg/min.
Milrinone - 0.125mcg/kg/min.

References

1. Ellender TJ, Skinner JC. The Use of Vasopressors and Inotropes in the Emergency Medical Treatment of Shock. Emerg Med Clin North Am. 2008;26(3):759-786. doi:https://doi.org/10.1016/j.emc.2008.04.001

2. Hollenberg SM. Vasoactive drugs in circulatory shock. Am J Respir Crit Care Med. 2011;183(7):847-855. doi:10.1164/rccm.201006-0972CI

3. Lampard JG, Lang E. Vasopressors for hypotensive shock. Ann Emerg Med. 2013;61(3):351-352. doi:10.1016/j.annemergmed.2012.08.028

Summarized by Jorge Chalit, OMSII | Edited by Meg Joyce & Jorge Chalit, OMSII

Tämä jakso on lisätty Podme-palveluun avoimen RSS-syötteen kautta eikä se ole Podmen omaa tuotantoa. Siksi jakso saattaa sisältää mainontaa.

Jaksot(1160)

Podcast 1007: Caffeine Pharmacology

Contributor: Travis Barlock, MD Educational Pearls: Caffeine Geography and Types: Caffeine is found throughout the world and has evolved independently in various plants that are not evolutionarily...

25 Touko 4min

Podcast 1006: Cannabinoid Pharmacology

Contributor: Travis Barlock, MD Educational Pearls: Endocannabinoid System: THC binds CB1 and CB2 receptors in neurons and immune cells Δ9-Tetrahydrocannabinol (THC) is the main psychoactive compo...

18 Touko 5min

Podcast 1005: Balanced Fluid vs Normal Saline in Pediatric Patients

Contributor: Aaron Lessen, MD Educational Pearls: There has long been many questions about which IV fluid is best for ED resuscitation Multiple adult studies have shown no clear benefit of balance...

11 Touko 2min

Carepoint Journal Club: Occlusion Myocardial Infarction

Carepoint Journal Club is a quarterly series with discussions about a medical topic, brought to you by Carepoint's Emergency Physicians.

7 Touko 25min

Podcast 1004: Sinus Arrest Post TAVR

Contributor: Taylor Lynch, MD Educational Pearls: Conduction abnormalities are a common and clinically significant complication in patients who undergo transcatheter aortic valve replacement (TAVR)...

4 Touko 4min

Podcast 1003: Nasal Intubation

Contributor: Alec Coston, MD Educational Pearls: What are nasal intubations and when do we use them? Nasal intubations function similarly to oral intubations with the end goal of passing an endotrac...

27 Huhti 9min

Podcast 1002: Elder Agitation

Contributor: Aaron Lessen, MD Educational Pearls: What are the common causes of agitation in the elderly? Baseline dementia causing a behavioral disturbance Delirium precipitated by an acute medical ...

20 Huhti 3min

Podcast 1001: Acute Intermediate Risk Pulmonary Embolism

Contributor: Aaron Lessen, MD Educational Pearls: Patients with pulmonary embolism (PE) are divided into three risk categories Low risk (non-massive PE): patients are stable Treatment: prescribe an...

13 Huhti 3min