Vasopressor resident survival guide
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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 α1 (Vasoconstrictive) *β1 (↑contractility) | *Mainly β1 (↑contractility) *α1(Vasoconstrictive) | *V1 receptor of GIT vasculatures *Antidiuretic effects | *Pure α1 (Vasoconstrictive) *No β1 | *Mainly β1 (↑contractility) *β2 arterial smooth muscle (Hypotensive) | ||||||||||||||||||||||||||||||||||||||||||||
| Indication | *1st line Septic shock *1st line 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 | Less tachyarrhythmia than Dopamine | Arrhythmia (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(Troponin > 10) *Gut ischemia | If hypotension, add α1 agonist | |||||||||||||||||||||||||||||||||||||||||||||
Do's
- Assess the cause of shock
- Always volume fluid resuscitation first
- Norepinephrine in undifferentiated shock.