MICU intern's survival guide vasopressors: Difference between revisions

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==Overview==
==Overview==
[[Shock]] is a common condition that interns have to encounter in the MICU. Some important ideas to keep in mind while managing shock are: determine the type of shock as the treatment is different for different shocks, norepinephrine can be used as a first line vasopressor in any shock and fluid resuscitation is an important first line management in all type of shocks except [[cardiogenic shock]].
[[Shock]] is a common condition that interns have to encounter in the MICU. Some important ideas to keep in mind while managing shock are: determine the type of shock as the treatment is different for different shocks, norepinephrine can be used as a first line vasopressor in any shock and fluid resuscitation is an important first line management in all type of shocks except [[cardiogenic shock]].
===Norepinephrine===
==Norepinephrine==
====Mechanism of action====  
====Mechanism of action====  
Acts on both alpha1 (vasoconstriction of blood vessels) and beta1 receptors (increases [[cardiac output]]).
Acts on both alpha1 (vasoconstriction of blood vessels) and beta1 receptors (increases [[cardiac output]]).
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====Doses====
====Doses====
* 1-30 mcg/min.
* 1-30 mcg/min.
===Dopamine===
===Dopamine===
====Mechanism of action====
====Mechanism of action====

Revision as of 16:13, 28 December 2012

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Overview

Shock is a common condition that interns have to encounter in the MICU. Some important ideas to keep in mind while managing shock are: determine the type of shock as the treatment is different for different shocks, norepinephrine can be used as a first line vasopressor in any shock and fluid resuscitation is an important first line management in all type of shocks except cardiogenic shock.

Norepinephrine

Mechanism of action

Acts on both alpha1 (vasoconstriction of blood vessels) and beta1 receptors (increases cardiac output).

Indications

Doses

  • 1-30 mcg/min.

Dopamine

Mechanism of action

  • Acts on alpha1 (vasoconstriction of blood vessels), beta1 (increases cardiac output) and dopamine receptors (scattered throughout the body).
  • Its action is dose dependent. At low doses it predominantly acts on cardiac receptors (1-10 mcg/min) with less vasoconstriction activities. At higher doses it has both vasoconstriction and cardiac activities.

Indications

Side-effects

  • Arrhythmogenic. Avoid in patients prone to arrhythmias.
  • Doses
  • 1-20 mcg/min.

Vasopressin

Mechanism of action

  • Acts by stimulating V1 (vasopressin) receptors in vascular and GI smooth muscles causing contraction. It also has anti-diuretics effect.

Indications

Side-effects

Doses

  • .03units/min (only vasopressor which is not titrated).

Phenylephrine

Mechanism of action

  • Acts only on alpha1 receptors (vasoconstriction). No action on cardiac receptors and is cardiac neutral.

Indications

Side-effects

Doses

  • 20-300 mcg/min

Dobutamine

Mechanism of action

  • Acts on Beta1 (increases cardiac output) and Beta2 receptor (vasodilatation). Thus, it increases cardiac output but increases the risks for hypotension too.

Indications

Side-effects

  • Tachyarrhythmias (B1 effect)
  • Hypotension (B2 effect)
  • In cases of hypotension with dobutamine add another vasopressor with alpha effects (norepinephrine or dopamine) with dobutamine.

Doses

  • 2.5 to 20mcg/kg/min (usually titrated by doctors and not ICU nurses)

References

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