Vasopressor Use

[Swe.Prehosp]

hey everyone. Im new on this forum.

Here`s a tip on some interesting info regarding vasoprossesors and blunt truama.

"Early Use of Vasopressors After Injury: Caution Before Constriction."

journal of Trauma-Injury Infection & Critical Care. 64(1):9-14, January 2008.

[Off Label]

Nearly 10 years later, maybe an update...

Dopamine...dirty drug. Sometimes you get what you want, sometimes more than you asked for...ie tachycardia when all you want is more blood pressure. Dose varies. I don't use it.

Epinepherine first line..inotrope of choice for me for contractility issues

Norepi...excellent drug for correction of loss of vasomotor tone. Bad reputation comes from the days when septic patients were relatively fluid restricted and squeezed to death with this drug, ie, end organ damage because of poor perfusion (lack of intravascular volume). We've learned a bit since those days.

Vasopressin...excellent drug when vasoplegia from whatever cause is refractory to NE or phenylephrine. Not first line, but very effective.

Dobutamine...an OK inotrope but could require a pressor for blood pressure as well. I'd pick epi first.

[kohlerrf]

Not a fan of vasopressors, they have a habit of constricting all the blood vessels in the body including the ones that supply the brain, in addition we all overdose our patients at one time or another because we lose track of time! I have heard, and am very interested, that they are experimenting on swine now using "vasodilators" in cardiac arrest and have had some promising results!