CCS: When to use vasoconstrictors if hypotensive? - apple09

[ArchivalUser]

If someone is has hypotension, is on fluids, and is going into surgery.. do you restore blood pressure with a vasoconstrictor by adding dopamine, phenylephrine, or NE to constrict vessels and restore BP if fluids don’t raise enough after surgery or before surgery?

[ArchivalUser]

any clarification?

[ArchivalUser]

you need to maintain a mean arterial pressure, MAP > 65 in shock cases. ( see below shock recognition and management from dr.red CCS)

Your first approach in shock is to determine the type of shock...there are clues on physical exam and in history that can help you with this. Determine if it is obstructive or cardiogenic or distributive ( septic/anaphylactic)or hypovolemic type of shock .

Obstructive shock can occur in tension pneumothorax or cardiac tamponade. In such cases, simply relieving the cause of obstruction ( e: thoracostomy in tension pneumo, tpa in pulmonary embolism, PERICARDIOCENTESIS IN CARDIAC TAMPONADE AND TRENDELENBERG POSITION IN AIR EMBOLISM) is enough to bring up the mean pressure. You must not use vasoconstrictors here without addressing the underlying issue here i.e; address obstruction first.

Hypovolemic and septic shocks must be given huge amounts of Normal saline first and if this does not bring up blood pressure , if not getting MAP > 65, vasopressors are started. Norepinephrine is the preferred pressor when there is tachycardia. Dopamine is preferred when there is concomitant cardiac component to shock.

Anaphylactic shock needs stat IV epinephrine and large amounts NS

[ArchivalUser]

Thanks so much.. so I wanted to clarify.. we use pressors basically for non-obstructive shocks? And the best pressor in tachycardia is NE, otherwise use dopamine? And of course, EPI for anaphylaxis.. ?

[ArchivalUser]

norepinephrine is the preferred pressor in many cases actually. If there is septic shock or tachycardia, NE is preferred over dopamine. The only situation dopamine gets preference is in cardiogenic shock or in cases of reduced cardiac output in mixed type of shocks