Podcast 853: Critical Care Medications - Vasopressors
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

Jaksot(1144)

Podcast 912: Narcan (Naloxone)

Podcast 912: Narcan (Naloxone)

Contributor: Taylor Lynch, MD Educational Pearls: Opioid Epidemic- quick facts Drug overdoses, primarily driven by opioids, have become the leading cause of accidental death in the U.S. for individu...

15 Heinä 20246min

Episode 911: Anticholinergic Toxicity

Episode 911: Anticholinergic Toxicity

Contributor: Taylor Lynch MD Educational Pearls: Anticholinergics are found in many medications, including over-the-counter remedies Medications include: Diphenhydramine Tricyclic antidepressa...

8 Heinä 20247min

Episode 910: Cellulitis Recovery Timeline

Episode 910: Cellulitis Recovery Timeline

Contributor: Aaron Lessen, MD Educational Pearls: How fast does cellulitis recover? A recent prospective cohort study took a look at this question. The study included 300 adults with cellulitis ...

2 Heinä 20241min

Episode 909: Prehospital Blood Pressure Management in Suspected Stroke

Episode 909: Prehospital Blood Pressure Management in Suspected Stroke

Contributor: Aaron Lessen MD Educational Pearls: A recent study assessed EMS treatment of high blood pressure in the field 2404 patients randomized to prehospital treatment (1205) vs. usual care ...

24 Kesä 20242min

Episode 908: Sympathomimetic Drugs

Episode 908: Sympathomimetic Drugs

Contributor: Taylor Lynch MD Educational Pearls: Overview: Sympathomimetic drugs mimic the fight or flight response, affecting monoamines such as dopamine, norepinephrine, and epinephrine Limited th...

17 Kesä 20247min

Episode 907: Wide-Complex Tachycardia

Episode 907: Wide-Complex Tachycardia

Contributor: Travis Barlock MD Educational Pearls: Wide-complex tachycardia is defined as a heart rate > 100 BPM with a QRS width > 120 milliseconds Wide-complex tachycardia of supraventricular or...

12 Kesä 20243min

Episode 906: Case Study of Hypernatremia

Episode 906: Case Study of Hypernatremia

Contributor: Aaron Lessen MD Educational Pearls: The case: A gentleman came in from a nursing home with symptoms concerning for sepsis. He was hypotensive, hypoxic, febrile, and mentally altered. ...

3 Kesä 20243min

Episode 905: Oseltamivir (Tamiflu) for Influenza

Episode 905: Oseltamivir (Tamiflu) for Influenza

Contributor: Aaron Lessem MD Educational Pearls:  Oseltamivir (Tamiflu) is an antiviral medication used commonly to treat influenza Trials show that the medication reduces the duration of illness ...

27 Touko 20242min

Suosittua kategoriassa Tiede

rss-mita-tulisi-tietaa
rss-poliisin-mieli
tiedekulma-podcast
rss-duodecim-lehti
docemilia
rss-lihavuudesta-podcast
utelias-mieli
radio-antro
rss-sosiopodi
sotataidon-ytimessa
mielipaivakirja
filocast-filosofian-perusteet
rss-laakaripodi
rss-radplus
rss-opeklubi
rss-luontopodi-samuel-glassar-tutkii-luonnon-ihmeita