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

Avsnitt(1145)

Podcast 810: Tooth Replantation

Podcast 810: Tooth Replantation

Contributor: Jarod Scott, MD Educational Pearls: There is a 1-hour window for tooth replantation in ED Cold milk is often best transport media unless there is access to specialized solutions (Hank's ...

5 Sep 20224min

Podcast 809: Achilles Tendon Rupture

Podcast 809: Achilles Tendon Rupture

Contributor: Aaron Lessen, MD Educational Pearls: Achilles tendon rupture usually presents in younger, healthy patients after a sports injury Patients typically present complaining of an abrupt onset...

30 Aug 20224min

Podcast 808: BVM and PEEP Valve

Podcast 808: BVM and PEEP Valve

Contributor: Dylan Luyten, MD Educational Pearls: Positive End Expiratory Pressure (PEEP) is positive pressure within the lungs and maintained throughout the entire respiratory cycle. It is the press...

29 Aug 20224min

Podcast 807: Ring Removal Tricks

Podcast 807: Ring Removal Tricks

Contributor: Jared Scott, MD Educational Pearls: If a patient is in significant pain, a digital block can be helpful. Pain management alone may allow for manual ring removal.  Ring cutters and trauma...

23 Aug 20224min

Podcast 806: Normal ECGs

Podcast 806: Normal ECGs

Contributor: Jared Scott, MD Educational Pearls: Physicians are typically advised not to trust computer interpretation of ECGs Retrospective study was done of computer interpreted normal ECGs to eva...

22 Aug 20223min

Podcast 805: Tunneled Peritoneal Catheter

Podcast 805: Tunneled Peritoneal Catheter

Contributor: Aaron Lessen, MD Educational Pearls: Patients with recurrent ascites may need frequent outpatient or emergency department paracentesis which can be time consuming and uncomfortable for p...

16 Aug 20223min

Podcast 804: Brugada Criteria for V Tach

Podcast 804: Brugada Criteria for V Tach

Contributor: Peter Bakes, MD Educational Pearls: Tachycardia describes a heart rate of >120 beats per minute Wide Complex describes a QRS duration of >120 ms or 3 small boxes on a standard EKG The ma...

9 Aug 20226min

Podcast 803:  Sedation During Intubation

Podcast 803: Sedation During Intubation

Contributor: Aaron Lessen, MD Educational Pearls: Awareness with recall of paralysis can occur in intubated and ventilated patients receiving paralytic medications  Patients who suffer from this eff...

8 Aug 20223min

Populärt inom Vetenskap

p3-dystopia
svd-nyhetsartiklar
pojkmottagningen
dumma-manniskor
allt-du-velat-veta
kapitalet-en-podd-om-ekonomi
det-morka-psyket
rss-vetenskapsradion
rss-experimentet
rss-ufo-bortom-rimligt-tvivel
paranormalt-med-caroline-giertz
medicinvetarna
rss-vetenskapsradion-2
bildningspodden
halsorevolutionen
dumforklarat
vetenskapsradion
rss-broccolipodden-en-podcast-som-inte-handlar-om-broccoli
4health-med-anna-sparre
rss-spraket