Post code drips

[Matthew89]

Sorry new to ICU. So I have a patient post code and they already have levo and epi running and they patient continues to be hypotensive. Can we just run vasopressin? Are levo and epi almost the same? If levo is not working why do we still hang epi? Sorry. Just want to know. Thanks.

[MunoRN, RN]

The action of Norepi is primarily vasoconstriction, epinephrine is an inotrope, chronotrope, and a vasoconstrictor. Sometimes you only want the vasoconstrictive effects which is where Norepi is preferable, sometimes when you're more on the cusp of cardiac arrest you need something that flogs the heart and cardiovascular system into sustaining enough function to sustain life.

Generally if you've got multiple pressors / inotropes already running you should consider if the patient's volume status is adequate enough for the pressors and inotropes to work. Also consider reversible causes of why they coded in the first place that could improve perfusion. Also, evaluate if the hypotension is actually translating into poor perfusion, sometimes a systolic of 80+ works just fine to create adequate perfusion. All that being said, it generally doesn't hurt to add vasopressin to the mix if you're running out of ideas.