Thanks for you responses. Yes, I have read UptoDate, as well as an older ICU book that I have. I posted the questions here because I wanted to get responses from nurses who have hands-on experience in these situations. There is only so much you can learn from books.
As an ER nurse and paramedic, I have had lots of pt's that presented with what can be called sympathetic-induced pulmonary edema. The pt presents with flash pulmonary edema and hypertension. These pt's I really liked getting when I worked on the ambulance because we could turn them around quickly with nitro spray and CPAP, to the point where they would go from being in acute distress on scene to calm and stable by the time we arrived at the ER.
However, I have little experience with pt's with cardiogenic shock. The only med on the ambulance that we ever had available to be used was dopamine (and event that was recently it was taken out of our protocols), but I never had occasion to use it in the field. In the ER, I have only seen a couple of patients in cardiogenic shock, and I remember the last one we had the doc ordered an epi drip. I wonder if that is really the right way to treat such a patient, or if dobutamine along with a vasopressor would be better. I know that dopamine has fallen out of favor.
In the ICU (where I have never worked), you probably have pt's who have acute heart failure with pulmonary edema, but you have stable BP's. UptoDate says dobutamine is the best drug for this situation. I understand that it has inotropic effects, which of course is what you would want, but that it also vasodilates. When I have asked co-workers in the ER about dobutamine, I have been told that it has fallen out of favor because of its vasodilatory effect, so I was surprised to see that UptoDate recommends it so strongly. (I was also surprised at how strongly they recommend Lasix, since in my experience with flash pulmonary edema patients it is not useful.)
Basically, I am not looking for book answers since I already know those myself. I am looking to hear from people with a lot more experience than I have to share their hands-on experiences with these issues. Thanks!