Which pressor to use??? - page 3
Hey guys! I work in a MSICU, but we had a pt the other day who was actively infarcting. Had been cathed a few weeks prior, diffuse CV disease, med management only. He went into resp distress on... Read More
May 27, '07neo causes reflex brady (baroreceptor reflex), so be cautious in pts who need the extra kick and rate
May 28, '07I agree with most everyone here who said that Levo would be there drug of choice for this pt. What type of infarct was it? If it was right sided volume would be the only thing that would truly help this patient.
Jun 5, '07In the future it woundn't hurt to set up a CVP. In this pt it could have gone on the triple lumen. Use a stopcock gang for multiple infusions, and set up a stopcock on the CVP sideport for intermittent infusions. But at least you'd be able to monitor anyway. Of course, SG is ideal. Someone said hit the doc on the head with the SG kit--good advice!
Jun 18, '07Dobutamine: causes vasodilation & hypotention NO WAY
Dopamine: will need a high dose for vasopressor causes tachycardia & don't know renal status of pt. Comes in renal doses
Epi: Strong med with bronchospams he may go tachy
Levo: quick to titrate & effect B/P & Maps >60 to keep my CABG grafts
I would have started the Levo 1st because it was in the room already
we also use Neo for our cardiac pt's. This will have been my 1st to use then the Levo. I
It's odd U didn't have a CVP tranducing on a cardiac pt. If U have an aline U should have a CVP for fluid status changes.
What was is UOP? What was his total I&0? What was his MAP? What was his H&H? What was his K, Mg, Creat. etc...
I could on, but U did great for #1 is the trendellenberg positon & side to side with calling for help & starting the Levophed.
Jun 19, '07I agree with everyone on here... I would have started the levo first. My hospital really doesn't use epi drips, we just use it in code situations. Levophed would be your best bet because it wouldn't increase the HR like dopamine and dobutamine do.
Was this patient septic by any chance? What was the WBC count?