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(1146)

Opioid Miniseries Part II: Limiting Opioids in the Emergency Department

Opioid Miniseries Part II: Limiting Opioids in the Emergency Department

RACTICE RECOMMENDATIONS 1. Opioids are inherently dangerous, highly addictive drugs with significant abuse potential, numerous side effects, lethality in overdose, rapid development of tolerance, and ...

8 Kesä 20171h 8min

Opioid Miniseries Part I: Medicine's Greatest Folly

Opioid Miniseries Part I: Medicine's Greatest Folly

The Emergency Medical Minute proudly presents an educational podcast series sponsored by the Colorado Hospital Association addressing our the United States' opioid epidemic.

7 Kesä 201749min

Podcast #215: Ankle Pain

Podcast #215: Ankle Pain

Author: Donald Stader, M.D. Educational Pearls: The most common ankle injury mechanism is an inversion. Most common broken bone in the ankle is the fibula. During exam, it is important to palpate ove...

7 Kesä 20174min

Podcast #214: Dizziness

Podcast #214: Dizziness

Author: Aaron Lessen, M.D. Educational Pearls: We can differentiate verto into benign problems such as vestibular problem (peripheral problem), or something more worrisome that originates in the brai...

5 Kesä 20171min

Podcast #213: Oats and Potatoes

Podcast #213: Oats and Potatoes

Author: Michael Hunt, M.D. Educational Pearls: Oats have been shown to lower LDL. Oat bran is the most effective way to consume oats to lower LDL. A Swedish study of 69,000 people who ate at least 3 ...

3 Kesä 20172min

Podcast #212: Knights Who Say Pessary

Podcast #212: Knights Who Say Pessary

Author: Jared Scott, M.D. Educational Pearls: A pessary is a device inserted into the vagina for medical purposes. Examples include birth control and mechanical support of the pelvic structures. In o...

1 Kesä 20173min

Podcast #211: E-cigarettes

Podcast #211: E-cigarettes

Author: Michael Hunt, M.D. Educational Pearls: Children under age of 6 are at greatest risk of accidental nicotine overdose from ingestion. Biphasic presentation: Hyperadrenergic = nausea, vomiting...

31 Touko 20173min

Podcast #210: Bear Mauling

Podcast #210: Bear Mauling

Author: Jared Scott M.D. Educational Pearls: Bear mauling is not a common issue in the ED. The Ursus americanus (black bear) is the most common in Colorado, but Ursus arctos horribilis (grizzly bear)...

28 Touko 20174min

Suosittua kategoriassa Tiede

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