table comparing pressor agents?

[OSUdoc08]

I haven't worked at a hospital OR prehospital service that didn't use biphasic in probably 5 years! where are you at?!

all lifepack 12's are biphasic which is probably one of the most commonly used prehospital and in hospital monitor/defibs.

later

Texas and Oklahoma.

The lifepack 12's I have used are monophasic.

Everytime I have shocked, we have done 200-300-360. From now on, I'll be doing 360, but obviously these are on monophasic machines.

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[Mman]

In my limited experience, the biphasic machines I have seen let you set the joules in monophasic equivalents. For example, when you dial in 360J, it automatically adjusts it to the equivalent biphasic setting. You really wouldn't even know the difference unless you knew the details of the machine.

 

[bulldog]

So it seems like levophed vs. dopamine is initial choice for pressors in sepsis.

After aggressive hydration, and levophed, if the patient is still hypotensive is there an algorithm for select vasopressin vs phenylephrine vs dopamine next? What's the third agent? What's the alst agent to ed?

If dopamine is chosen as initial agent, what's the 2nd, 3rd, and 4th agent and what's the logic behind that?

I've tried reading on pubmed and can't seem to find a good algorithm. Seems like what i see in icu is arbitrary with the pressors that senior residents choose.

I've seen: Levo-->vaso-->phenyl-->dopa.

 

[corpsmanUP]

My little secret in the ICU for pressure issues. I keep a 50ml bag of Phenylephrine in case I need to immediately bolus someone on call when I am the only chap around. It takes time to get a nurse to pull a pressore from the Pixis and I can have 1-2 ml (100mcg/cc) drawn up and given in less than 30 seconds. I learned this from an anesthesia colleague who would mix it for me each call day. It helped many times.This is a freaking great thread. Lets get it back on track though. Roja..your scanned document por favor...keeping me in suspense!! Also, what fellowship are you doing?

OSUdoc- you offer some great street smarts and I share a a common background with you as many here do. Don't underestimate how a couple of years of residency will change your practice philosophy from a more "black/white" to a "many shades of gray" outlook.

Jeff- I too will be back in Texas as soon as I am done!! I've loved the experiences up north and look forward to the next 20 months with my inlaws in Pa, but I look forward to being back with my people!!

My little secret in the ICU for pressure issues. I keep a 50ml bag of Phenylephrine in case I need to immediately bolus someone on call when I am the only chap around. It takes time to get a nurse to pull a pressore from the Pixis and I can have 1-2 ml (100mcg/cc) drawn up and given in less than 30 seconds. I learned this from an anesthesia colleague who would mix it for me each call day. It helped many times.