Vasopressor resident survival guide: Difference between revisions
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:*Always volume fluid resuscitation first | :*Always volume fluid resuscitation first | ||
:*Norepinephrine in undifferentiated shock. | :*Norepinephrine in undifferentiated shock. | ||
:*Titrate dobutamine according to clinical response slowly ( 2-20 ug/kg/min ) to avoid tachycardia (10% increase from the baseline). The benefit that dobutamine has as minimal effect on myocardial oxygen demand is lost if it is not well titrated. | |||
==Don'ts== | ==Don'ts== | ||
Revision as of 17:54, 6 December 2013
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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 (↑ cardiac contractility) * some α1 agonist(Vasoconstrictive) | *V1 receptor of GIT vasculatures *Antidiuretic effects | *Pure α1 agonist(Vasoconstrictive) *No β1 | *Predominant β1 agonist (↑contractility) *β2 arterial smooth muscle (Hypotensive) | ||||||||||||||||||||||||||||||||||||||||||||
| Indication | *1st line in : *Septic shock *Cardiogenic shock *Undifferentiated shock | 2nd line septic 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 β1 effect} ( less than Dopamine ) | Arrhythmia (more β1) | *Coronary spasm *Splanchnic vasoconstriction | Reflex bradycardia (only α1) | Hypotension (β2) | ||||||||||||||||||||||||||||||||||||||||||||
| Cautions | Arrhythmia | *Not in cardiogenic shock *Arrhythmia *Ischemia induced cardiotoxicity | *Ischemic heart *Gut ischemia | *Bradycardia *Heart block | *Hypotension (add α1 agonist) | ||||||||||||||||||||||||||||||||||||||||||||
Do's
- Assess the cause of shock
- Always volume fluid resuscitation first
- Norepinephrine in undifferentiated shock.
- Titrate dobutamine according to clinical response slowly ( 2-20 ug/kg/min ) to avoid tachycardia (10% increase from the baseline). The benefit that dobutamine has as minimal effect on myocardial oxygen demand is lost if it is not well titrated.
Don'ts
- Do not start with low dose Dopamine dose to perfuse the kidney.