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STEMI and Dopamine


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Specializes in ED. Has 7 years experience.

Did you miss what I said about small, repeated fluid challenges to effect, getting a line in to facilitate infusion and monitor CVP etc etc?

Catacholomines used to improve cardiac performance/contractility does have its drawbacks some possibly detrimental (dopamine in particular) but this patient was extremely shocky..... yes appropriate/adequaten fluids are important. Did I imply otherwise?

No, I read your post; however, I want to emphasize that starting pressors prior to preload augmentation could exacerbate the situation.

It may be a inferior wall MI with RV infarct. But all in all we need a pressure, the patient needs perfusing pressure.

A. Start Levophed or Dopamine as well a a 250cc bolus of albumin or NS

B. Watch patients pressure and heart rate and any funky arrythmias

C. Call Cath Lab team Stat!

B. Insert IABP stat and I qoute, " The goal of the IAB in such a disease stat (such as cardiogenic shock) is to decrease or "optimize" preload by ensuring a filling pressure high enough to obtain the highest CO on the Starling curve but not so high as to cause pulmonary congestion." (Counterpulsation Applied, An introduction to Intra-Aortic Balloon Pumping).

Again the importance is to agressively treat BP and HR stabilize patient for cath lab. The patient also needs an A-line, and a Swan-Ganz for hemodynamics.

Oh I forgot he needs to pray.

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