Podcast 853: Critical Care Medications - Vasopressors

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

Jaksot(1147)

Podcast #295: UTI

Podcast #295: UTI

Author: Sam Killian, M.D. Educational Pearls Traditionally, UTI diagnosis has been dependent on urine culture, urinalysis and clinical symptoms. But a recent study casts some doubt on the utility of ...

26 Tammi 20184min

Podcast #294: Rhabdomyolysis

Podcast #294: Rhabdomyolysis

Author: Michael Hunt, M.D. Educational Pearls Rhabdomyolysis is caused by the destruction of skeletal muscle that leads to the release of myoglobin, which causes renal failure. It presents with pain ...

22 Tammi 20183min

Podcast #293: Transient Global Amnesia

Podcast #293: Transient Global Amnesia

Author: Sam Killian, M.D. Educational Pearls Transient global amnesia is a paroxysmal, transient memory issue. Remote and immediate memory is preserved, but new memories cannot be made. Patients will...

19 Tammi 20184min

Podcast #292: Hypercalcemia

Podcast #292: Hypercalcemia

Author: John Winkler, M.D. Educational Pearls Normally, the parathyroid is the master regulator of serum Ca levels. It secretes PTH, which stimulates calcium uptake from the bone and gut. Causes of ...

17 Tammi 20182min

Podcast #291: Cincinnati Stroke Scale

Podcast #291: Cincinnati Stroke Scale

Author: Nick Hatch, M.D. Educational Pearls The Cincinnati Stroke Scale uses 3 measures to screen for ischemic stroke. The measures are: facial asymmetry, speech quality and arm drift. This scale is ...

15 Tammi 20182min

Podcast #290: The Biochemistry of DKA

Podcast #290: The Biochemistry of DKA

Author: Dave Rosenberg, M.D. Educational Pearls DKA commonly causes hyperkalemia, leading to peaked T-waves on ECG. However, DKA causes hypokalemia at the same time. In DKA, glucose cannot be taken i...

12 Tammi 20186min

Podcast #289: Cannabinoid Hyperemesis

Podcast #289: Cannabinoid Hyperemesis

Author: Dylan Luyten, M.D. Educational Pearls Cannabinoid Hyperemesis syndrome is a relatively new diagnosis that presents with vomiting and abdominal pain without a clear etiology in the setting of ...

10 Tammi 20183min

Podcast #288: Diarrhea

Podcast #288: Diarrhea

Author: Peter Bakes, M.D. Educational Pearls Chronic diarrhea is defined as 3 or more loose, watery stools lasting more than 2-3 weeks. Look for clues in the history, including travel (could suggest...

8 Tammi 20187min

Suosittua kategoriassa Tiede

rss-poliisin-mieli
rss-mita-tulisi-tietaa
tiedekulma-podcast
docemilia
rss-luontopodi-samuel-glassar-tutkii-luonnon-ihmeita
rss-duodecim-lehti
radio-antro
utelias-mieli
filocast-filosofian-perusteet
rss-lapsuuden-rakentajat-podcast
rss-lihavuudesta-podcast
rss-sosiopodi