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How safe is it to be on a drip of dobutamine 4 mcg/kg,/min, 5 Mg. IV X 2 followed by 25 mg po of metoprolol followed by 100 mg of lasix po, in a patient with extensive scleroderma causing pulmonary fibrosis and SEVERE pulmonary htn, who presented 1 day ago with RHF (probably acute cor pulmonale) and ARF (cr. 3.6). This patient was sat. in the high 80's low 90's on 10L , was consistently running tachy around 100 bpm and pressures were around 80/50?
It seemes to me that fluid loading rather than unloading and a vasoconstrictor is a better method of the treatment in this scenerio of RHF (optimize frank-starling). What physiological reason would push you to choose dobutamine (beta -2/vasodialator) rather than another inotrope w/o vasodilatory properties, something like dopamine? Her lungs were completely clear. Maybe I'm missing something here. Is it to reduce pulmonary pressures at the expense of ventricular filling?
Also, how safe is Dobutamine in ARF. Do you have to adjust the dose? I presume it causes N/V like Digoxin does.
Patient felt out of breath, then N/V possibly even aspirated, 15 min. of ACLS for asystole. Anybody have any experience with this situation?
It seemes to me that fluid loading rather than unloading and a vasoconstrictor is a better method of the treatment in this scenerio of RHF (optimize frank-starling). What physiological reason would push you to choose dobutamine (beta -2/vasodialator) rather than another inotrope w/o vasodilatory properties, something like dopamine? Her lungs were completely clear. Maybe I'm missing something here. Is it to reduce pulmonary pressures at the expense of ventricular filling?
Also, how safe is Dobutamine in ARF. Do you have to adjust the dose? I presume it causes N/V like Digoxin does.
Patient felt out of breath, then N/V possibly even aspirated, 15 min. of ACLS for asystole. Anybody have any experience with this situation?