If I have someone under 1 MAC of anesthesia with SBP 160s and a HR of 40, they are getting hydralazine or a nitroglycerin like medication, to achieve both the goals of lowering the SBP and increasing HR.. This combo of HTN and bradycardia could mean an intracranial injury
If this particular septic person has a SBP of 160s, my first move would be to turn down the levophed. On a good amount of levo and still HR 40 I would have in the back of my mind this could be heart block and we may need to pace, rare but its a thought in my mind
You must be facile at controlling any and all hemodynamic parameters...between Beta blockers, Nitrates, Phenylephrine, glyco, Ephedrine, levophed/epi - you should be able to make anyones numbers anything you want.
I rarely use vasopressin (only when extreme doses of neo/epi not going the job which is very very rare)
What hemodynamics do I want for a septic person?
I want MAP 50-60. I want HR 90-130. I want Fio2 as high as it can be and HCT > 25 at least.
At some point the HR of 140+ is counterproductive. I see people with rapid AF on levo from the ICU all the time, switch it over to neo for instantly better rate control and still able to maintain good MAPs