Podcast 853: Critical Care Medications - Vasopressors

<p dir="ltr"><strong>Contributor:</strong> Travis Barlock MD</p> <p dir="ltr"><strong>Educational Pearls:</strong></p> <ul> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">Three categories of pressors: inopressors, pure vasoconstrictors, and inodilators</p> </li> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">Inopressors: </p> </li> <ul> <li dir="ltr" aria-level="2"> <p dir="ltr" role="presentation">Epinephrine - nonselective beta- and alpha-adrenergic agonism, leading to increased cardiac contractility, chronotropy (increased heart rate), and peripheral vasoconstriction. Dose 0.1mcg/kg/min.</p> </li> <li dir="ltr" aria-level="2"> <p dir="ltr" role="presentation">Levophed (norepinephrine) - more vasoconstriction peripherally than inotropy; useful in most cases of shock. Dose 0.1mcg/kg/min.</p> </li> </ul> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">Peripheral vasoconstrictors:</p> </li> <ul> <li dir="ltr" aria-level="2"> <p dir="ltr" role="presentation">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.</p> </li> <li dir="ltr" aria-level="2"> <p dir="ltr" role="presentation">Vasopressin - No effect on cardiac contractility. Fixed dose of 0.4 units/min.</p> </li> </ul> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">Inodilators are useful in cardiogenic shock but often not started in the ED since patients mostly have undifferentiated shock</p> </li> <ul> <li dir="ltr" aria-level="2"> <p dir="ltr" role="presentation">Dobutamine - start at 2.5mcg/kg/min.</p> </li> <li dir="ltr" aria-level="2"> <p dir="ltr" role="presentation">Milrinone - 0.125mcg/kg/min.</p> </li> </ul> </ul> <p dir="ltr"><strong>References</strong></p> <p dir="ltr">1. Ellender TJ, Skinner JC. The Use of Vasopressors and Inotropes in the Emergency Medical Treatment of Shock. Emerg Med Clin North Am. 200