Vasopressor resident survival guide: Difference between revisions

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Revision as of 16:15, 6 December 2013

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Zaghw, M.D. [2]

Definition

Causes

Life Threatening Causes

Common Causes

Prognosis

Management

Vasopressors

Norepinephrine

Dopamine

Vasopressin

Phenylephrine

Dobutamine

Mechanism

*Mainly predominantα1 agonist (Vasoconstrictive)
*some β1 agonist (↑contractility)

*Mainly predominant β1 agonist (↑contractility)
* some α1 agonist(Vasoconstrictive)

*V1 receptor of GIT vasculatures
*Antidiuretic effects

*Pure α1 agonist(Vasoconstrictive)
*No β1

*Mainly predominant β1 agonist (↑contractility)
*β2 arterial smooth muscle (Hypotensive)

Indication

*1st line in :
*Septic shock
*Cardiogenic shock
*Undifferentiated shock

2nd line septic shock

1st line Neurogenic shock
3rd-4th line septic shock

*1st line cardiogenic shock
* low output septic shock

Dose

1-30 mcg/kg/min

1-20 mcg/min

0.03 unit/min

20-300 mcg/kg/min

2.5-20 mcg/kg/min

Complications

Tachyarrhythmia less than Dopamine (less β1 effect)

Arrhythmia (more β1)

*Coronary spasm
*Splanchnic vasoconstriction

Reflex bradycardia
(no worsening of tachycardia)
(only α1)

Hypotension (β2)

Cautions

Arrhythmia

*Not in cardiogenic shock
*Arrhythmia
*cardiotoxicity with ischemia

*Ischemic heart
if (Troponin > 10)
*Gut ischemia

Bradycardia
Heart block

If hypotension, add α1 agonist

Do's

Assess the cause of shock
Always volume fluid resuscitation first
Norepinephrine in undifferentiated shock.

Don'ts

References

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@@ Line 23: / Line 23: @@
 {{Family tree | | | | | B01 | | B02 | | B03 | | B04 | | B05 | |B01='''Norepinephrine''' |B02='''Dopamine''' |B03='''Vasopressin''' |B04='''Phenylephrine'''|B05='''Dobutamine''' }}
 {{Family tree | | | | | |!| | | |!| | | |!| | | |!| | | |!| | |}}
-{{Family tree | C01 | | C02 | | C03 | | C04 | | C05 | | C06 | |C01= '''Mechanism''' |C02= *Mainly '''α1''' agonist (Vasoconstrictive) <br> *β1 agonist (↑contractility) |C03= *Mainly '''β1''' agonist (↑contractility) <br> *α1 agonist(Vasoconstrictive)|C04= *'''V<sub></sub>1''' receptor of GIT vasculatures <br> *Antidiuretic effects |C05= *'''Pure α1''' agonist(Vasoconstrictive) <br> *No β1 |C06= *Mainly '''β1''' agonist (↑contractility) <br> *β2 arterial smooth muscle (Hypotensive)  }}
+{{Family tree | C01 | | C02 | | C03 | | C04 | | C05 | | C06 | |C01= '''Mechanism''' |C02= *Mainly predominant'''α1''' agonist (Vasoconstrictive) <br> *some β1 agonist (↑contractility) |C03= *Mainly predominant '''β1''' agonist (↑contractility) <br> * some α1 agonist(Vasoconstrictive)|C04= *'''V<sub></sub>1''' receptor of GIT vasculatures <br> *Antidiuretic effects |C05= *'''Pure α1''' agonist(Vasoconstrictive) <br> *No β1 |C06= *Mainly predominant '''β1''' agonist (↑contractility) <br> *β2 arterial smooth muscle (Hypotensive)  }}
 {{Family tree | | | | | |!| | | |!| | | |!| | | |!| | | |!| | |}}
-{{Family tree | D01 | | D02 | | D03 | | D04 | | D05 | | D06 | |D01= '''Indication''' |D02= *1st line '''Septic shock''' <br>*1st line '''Cardiogenic shock''' <br>*Undifferentiated shock |D03= 2nd line septic shock |D04= 2nd line septic shock |D05= 1st line '''Neurogenic shock''' <BR> 3rd-4th line septic shock |D06= *1st line '''cardiogenic shock''' <BR>* low output septic shock }}
+{{Family tree | D01 | | D02 | | D03 | | D04 | | D05 | | D06 | |D01= '''Indication''' |D02= *1st line in : <br> *'''Septic shock''' <br> *'''Cardiogenic shock''' <br>*Undifferentiated shock |D03= 2nd line septic shock |D04= 2nd line septic shock |D05= 1st line '''Neurogenic shock''' <BR> 3rd-4th line septic shock |D06= *1st line '''cardiogenic shock''' <BR>* low output septic shock }}
 {{Family tree | | | | | |!| | | |!| | | |!| | | |!| | | |!| | |}}
 {{Family tree | E01 | | E02 | | E03 | | E04 | | E05 | | E06 | |E01= '''Dose''' |E02= 1-30 mcg/kg/min |E03= 1-20 mcg/min |E04= 0.03 unit/min |E05= 20-300 mcg/kg/min |E06= 2.5-20 mcg/kg/min }}
 {{Family tree | | | | | |!| | | |!| | | |!| | | |!| | | |!| | |}}
-{{Family tree | F01 | | F02 | | F03 | | F04 | | F05 | | F06 | |F01= '''Complications''' |F02= Less tachyarrhythmia (less β1) than Dopamine |F03= Arrhythmia (more β1)   |F04= *Coronary spasm<br>*Splanchnic vasoconstriction|F05= Reflex bradycardia <br> No worsening of Tachycardia <br>(only α1) |F06= Hypotension (β2) }}
+{{Family tree | F01 | | F02 | | F03 | | F04 | | F05 | | F06 | |F01= '''Complications''' |F02= Tachyarrhythmia less than Dopamine (less β1 effect) |F03= Arrhythmia (more β1)   |F04= *Coronary spasm<br>*Splanchnic vasoconstriction|F05= Reflex bradycardia <br> (no worsening of tachycardia) <br>(only α1) |F06= Hypotension (β2) }}
 {{Family tree | | | | | |!| | | |!| | | |!| | | |!| | | |!| | |}}
-{{Family tree | G01 | | G02 | | G03 | | G04 | | G05 | | G06 | |G01= '''Cautions''' |G02= Arrhythmia |G03= *Not in cardiogenic shock <br>*Arrhythmia <br> *cardiotoxicity with ischemia |G04= *Ischemic heart <br>if (Troponin > 10) <br> *Gut ischemia |G05= |G06= If hypotension, add α1 agonist }}
+{{Family tree | G01 | | G02 | | G03 | | G04 | | G05 | | G06 | |G01= '''Cautions''' |G02= Arrhythmia |G03= *Not in cardiogenic shock <br>*Arrhythmia <br> *cardiotoxicity with ischemia |G04= *Ischemic heart <br>if (Troponin > 10) <br> *Gut ischemia |G05= Bradycardia <br> Heart block |G06= If hypotension, add α1 agonist }}
 {{Family tree/end}}