Vasopressor Use

[jjones1418]

Just some food for thought, and because I need something good to read...

Anyone care to discuss their use of vasopressors and the rationale for using a specific one? This is directed to you MD guys as well. I'm just looking for a few points of view, as to compare and contrast to current rationales that I have heard.

Also, if you want, discuss interchanging other medications with vasopressors and how ya do it.

[AZCEP]

We've only got two choices: epinephrine or dopamine.

[Capman]

Also, if you want, discuss interchanging other medications with vasopressors and how ya do it.

jjones', It's pretty much protocol based. We really don't have the luxury of performing ad lib with our medications on emergencies. As for PIFT transfers where we are responsible for many medications, these sort of considerations are usually thought out by the physicians prior to the transport. I'm pretty sure however; that you were referring to the on board drug box though, and as mentioned, Epi' and Dopamine are all I can think of in the classic vasoconstrictive/vasopressor sense.

If you could offer a little bit more to the question, we could probably go in depth just a bit more. I'm just not sure that I am answering this correctly for you as of yet.

Thanks

[medcitool]

We use dopamine, dobutamine, epi and vasopressin. No real difference in my opinion with epi and vasopressin. However dopamine sucks for acute MI bradycardia and dobutamine is great was restoring hemodynamic stability in that situation with cardiotoxic effects like dopamine. Don't know what else to say.

[medic001918]

There's actually a large difference between epi and vasopressin. Vasopressin works only on alpha receptors and has no electrical impact on the heart. Epi has alpha and beta effects, so you'll see an increased electrical activity with it's use. While protocol says they're interchangable, if you give some thought to the patient's problem (electrical, fluid or pump) you can figure out which might lend itself to your given situation. I tend to use vasopressin in VF/VT arrests (since there's an already irritable focus), and I'll use epi in the case of asystole or slow PEA's.

Just my two cents.

Shane

NREMT-P

[Ridryder 911]

We carry the usual Dopamine and Epi, Vasopressin, and Dobutrex as well. We are considering Levophed. Personally, I like the Dobutamine and Dopamine (preload and afterload factor). I realize Levophed used to be considered a last ditch effort (Levophed leaves them dead) but, early use appears to be promising.

What is lacking is early use of IABP with use of vasopressors. It is much easier to wean them off and as well decrease permanent renal damage as well.

R/r 911

[Scaramedic]

Levophed is making a comeback? What's next intracardiac injection? Cadillac ambulances?

[akroeze]

I don't know about you guys but I've already started using Watt seconds instead of Joules for defib.

[Scaramedic]

I don't know about you guys but I've already started using Watt seconds instead of Joules for defib.

[Ridryder 911]

I wished Cadillacs would come back It would be nice to have a smooth ride again.

Actually, I see far more Levoped drips than Epi, Vasopressor, and even Dobutamine drips. It is far more effective as a alpha agent.

I agree, I was hesitant at first, but if used properly I see it works great (especially cold sepsis shock). With I.V. pumps being used routinely in the field, it is now safer to use.

I am wondering, how many EMS has balloon pumps for critical care transports?

R/r 911