Vasopressor resident survival guide: Difference between revisions

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{{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 | 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 | | | | | |!| | | |!| | | |!| | | |!| | | |!| | |}}
{{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 | E01 | | E02 | | E03 | | E04 | | E05 | | E06 | |E01= '''Dose''' |E02= 1-30 mcg/min |E03= 2-20 mcg/min |E04= 0.03 unit/min |E05= 20-300 mcg/kg/min |E06= 2.5-20 mcg/kg/min }}
{{Family tree | | | | | |!| | | |!| | | |!| | | |!| | | |!| | |}}
{{Family tree | | | | | |!| | | |!| | | |!| | | |!| | | |!| | |}}
{{Family tree | F01 | | F02 | | F03 | | F04 | | F05 | | F06 | |F01= '''Complications''' |F02= Tachyarrhythmia {less β1 effect} <br>( less than Dopamine ) |F03= Arrhythmia (more β1)  |F04= *Coronary spasm<br>*Splanchnic vasoconstriction|F05= Reflex bradycardia <br>(only α1) |F06= Hypotension (β2) }}
{{Family tree | F01 | | F02 | | F03 | | F04 | | F05 | | F06 | |F01= '''Complications''' |F02= Tachyarrhythmia {less β1 effect} <br>( less than Dopamine ) |F03= Arrhythmia (more β1)  |F04= *Coronary spasm<br>*Splanchnic vasoconstriction|F05= Reflex bradycardia <br>(only α1) |F06= Hypotension (β2) }}

Revision as of 23:56, 6 December 2013

Sepsis Microchapters

Home

Patient Information (Adult)

Patient Information (Neonatal)

Overview

Pathophysiology

Causes

Differentiating Sepsis from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

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Case #1

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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/min
 
2-20 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.

References

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