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

Episoder(1147)

Podcast # 474: Obesity Hypoventilation Syndrome

Podcast # 474: Obesity Hypoventilation Syndrome

Author: Peter Bakes, MD Educational Pearls: The differential diagnosis for pedal edema includes issues in the heart, kidney, and liver Obesity hypoventilation syndrome (OHS) is an important and commo...

29 Mai 20199min

Podcast # 473: Direct to Consumer Antibiotics

Podcast # 473: Direct to Consumer Antibiotics

Author: Sam Killian, MD Educational Pearls: A recent study in Pediatrics compared the rates of antibiotic prescriptions for acute respiratory infections (ARIs) between direct to consumer (DTC) teleme...

24 Mai 20193min

Podcast # 472: SMART Crystalloids

Podcast # 472: SMART Crystalloids

Author: Gretchen Hinson, MD Educational Pearls: In most healthcare settings, normal saline (NS) has become ubiquitous as an intravenous fluid despite some potential drawbacks Compared to normal salin...

23 Mai 20195min

Podcast # 471: Cyclic Vomiting

Podcast # 471: Cyclic Vomiting

Author: Don Stader, MD Educational Pearls: Cyclic vomiting syndrome (CVS) is different than cannabis hyperemesis syndrome (CHS). It is important to differentiate the two. CHS is thought to be caused ...

21 Mai 20194min

Podcast # 470: Zofran and Pregnancy

Podcast # 470: Zofran and Pregnancy

Author: Jared Scott, MD Educational Pearls: Ondansetron (Zofran) is one of the latest drugs that has had concerns raised about side effects, particularly in pregnancy 2018 study probed two birth defe...

17 Mai 20193min

Podcast # 469: Go PO

Podcast # 469: Go PO

Author: Dave Rosenberg, MD Educational Pearls: Nothing by mouth (NPO) status routinely used before surgery to reduce the theoretical risk of aspiration However, surgery poses a large physiological st...

16 Mai 20193min

Podcast # 468: Typhlitis

Podcast # 468: Typhlitis

Educational Pearls: Tiflitis refers to the presence of enterocolitis in the setting of neutropenia - also known as neutropenic enterocolitis Commonly a result of chemotherapy for hematologic malignan...

14 Mai 20192min

Podcast # 467: Cauda Equina Syndrome

Podcast # 467: Cauda Equina Syndrome

Author: Erik Verzemnieks, MD Educational Pearls: Cauda equina syndrome is caused by the compression of the nerve roots that extend beyond the termination of the spinal cord Trauma, infection, hematom...

9 Mai 20192min

Populært innen Vitenskap

fastlegen
tingenes-tilstand
rekommandert
jss
liberal-halvtime
rss-rekommandert
rss-paradigmepodden
villmarksliv
sinnsyn
forskningno
pod-britannia
dekodet-2
fjellsportpodden
rss-overskuddsliv
tidlose-historier
rss-lundqvist-podden
hva-er-greia-med
rss-nysgjerrige-norge
tomprat-med-gunnar-tjomlid
noen-har-snakket-sammen