Podcast 853: Critical Care Medications - Vasopressors
Emergency Medical Minute29 Mai 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

Episoder(1146)

Podcast #221: Walking Corpse Syndrome

Podcast #221: Walking Corpse Syndrome

Podcast #221: Walking Corpse Syndrome Author: Erik Verzemnieks, M.D. Educational Pearls Walking Corpse Syndrome (aka Cotard Delusion) is a very rare psychiatric disorder that leads to the belief that...

25 Jun 20171min

Podcast #220: A-Fib Cardioversion

Podcast #220: A-Fib Cardioversion

Author: Aaron Lessen, M.D. Educational Pearls Atrial fibrillation is common. One of the best treatments for a fib is cardioversion back into sinus rhythm. Cardioversion may increase stroke risk if A-...

23 Jun 20172min

Podcast #219: History of Sepsis

Podcast #219: History of Sepsis

Author: Chris Holmes, M.D. Educational Pearls "Sepo' is a term from Homer (author of The Iliad and The Odyssey), and means "I rot". Hippocrates in 400 BC identified sepsis as a "dangerous decay withi...

21 Jun 20176min

Podcast #218: Estimating Pediatric Weight

Podcast #218: Estimating Pediatric Weight

Author: Aaron Lessen, M.D. Educational Pearls Asking parents and Broselow Tape are common options for estimating pediatric weight. Equipment sizes should not be adjusted for under/overweight kids bas...

19 Jun 20172min

Podcast #217: Designer Drugs

Podcast #217: Designer Drugs

Author: John Winkler, M.D. Educational Pearls: Designer, or "synthetic" drugs include bath salts, synthetic THC, and many others. Many of these drugs are originally manufactured in China and are ship...

17 Jun 20173min

Podcast #216: Roller Coasters and Kidney Stones

Podcast #216: Roller Coasters and Kidney Stones

Author: Aaron Lessen, M.D. Educational Pearls: Anecdotal evidence suggests that roller coasters may help with kidney stones. A recent study used a model of a kidney and ureter with different sized s...

13 Jun 20171min

Opioid MIniseries Part IV: Harm Reduction

Opioid MIniseries Part IV: Harm Reduction

PRACTICE RECOMMENDATIONS 1. Patients who abuse opioids should be managed without judgement; addiction is a medical condition and not a moral failing. Caregivers should endeavor to meet patients "where...

8 Jun 201748min

Opioid Miniseries Part III: Alternative to Opioids

Opioid Miniseries Part III: Alternative to Opioids

PRACTICE RECOMMENDATIONS 1. All emergency departments should implement ALTO programs and provide opioid-free pain treatment pathways for the following conditions: a. Acute on chronic opioid-tolerant r...

8 Jun 201749min

Populært innen Vitenskap

fastlegen
rekommandert
tingenes-tilstand
jss
rss-rekommandert
liberal-halvtime
villmarksliv
forskningno
sinnsyn
fjellsportpodden
rss-paradigmepodden
nevropodden
rss-nysgjerrige-norge
tidlose-historier
vett-og-vitenskap-med-gaute-einevoll
diagnose
smart-forklart
pod-britannia
dekodet-2
hva-er-greia-med