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(1147)

Podcast # 336: Hypokalemia

Podcast # 336: Hypokalemia

Author: Dylan Luyten, MD Educational Pearls:   Most important questions to answer with low potassium are 1. What are their symptoms? 2. Can they take potassium by mouth? Oral repletion is faster, c...

31 Maj 20183min

Podcast # 335: Blunt Head Trauma

Podcast # 335: Blunt Head Trauma

Author: Peter Bakes, M.D. Educational Pearls: Epidural hematomas have a characteristic convex appearance on CT while a subdural hematoma will have a concave appearance. Indications for operative ...

29 Maj 20188min

Podcast #334 - Resuscitative Thoracotomy

Podcast #334 - Resuscitative Thoracotomy

Author: Dylan Luyten, MD Educational Pearls: Resuscitative thoracotomies are most commonly used for treatment of cardiac tamponade and to selectively perfuse the brain and heart in setting of hemor...

25 Maj 20187min

Podcast #333 - TBI Prognosticators

Podcast #333 - TBI Prognosticators

Author: Michael Hunt, MD Educational Pearls: Studies have shown that patients with decreasing GCS scores have worse outcomes, however GCS of 4 has worse outcome than GCS 3. Alternative scoring sy...

23 Maj 20183min

Podcast #332 - Door To Furosemide Time

Podcast #332 - Door To Furosemide Time

Author: Nick Hatch, MD Educational Pearls: Recent study argues that CHF patients receiving furosemide within 60 minutes of arrival had a lower in-hospital mortality than those receiving it after (2...

21 Maj 20182min

Podcast # 331:  Oral Rehydration Therapy (ORT)

Podcast # 331: Oral Rehydration Therapy (ORT)

Author: Nick Hatch, MD Educational Pearls: The sodium-glucose cotransporter in the gut is essential for rehydration. Oral rehydration therapies require an equimolar concentration of glucose and s...

19 Maj 20184min

Podcast # 330:  Behcet Disease

Podcast # 330: Behcet Disease

Author: Nick Hatch, MD Educational Pearls: Behcet Disease is an autoimmune disease that can affect any organ system. Typical symptoms include recurrent oral and genital ulcers, but more concernin...

17 Maj 20184min

Podcast # 329:  Hypokalemic Periodic Paralysis

Podcast # 329: Hypokalemic Periodic Paralysis

Author: Dylan Luyten , MD Educational Pearls: Rare autosomal dominant condition that is often misdiagnosed as a psychiatric illness. Presents as profound muscle weakness with frank paralysis that...

15 Maj 20183min

Populärt inom Vetenskap

p3-dystopia
dumma-manniskor
svd-nyhetsartiklar
allt-du-velat-veta
medicinvetarna
rss-ufo-bortom-rimligt-tvivel
rss-experimentet
rss-vetenskapsradion-2
rss-vetenskapsradion
det-morka-psyket
sexet
kapitalet-en-podd-om-ekonomi
hacka-livet
dumforklarat
pojkmottagningen
rss-arkeologi-historia-podden-som-graver-i-vart-kulturlandskap
rss-personlighetspodden
paranormalt-med-caroline-giertz
vetenskap-och-halsa
halsorevolutionen