Paucis Verbis card: Vasopressors and Inotropes for Shock

The treatment of shock should focus on correcting the underlying pathophysiology. With persistent hemodynamic instability, a vasopressor and/or inotrope should be selected. Reviewing receptor physiology can help you select the best-fit agent for the patient’s clinical condition. There is an especially useful table on medication selection in the reviewed 2008 EM Clinics of North America article.

This installment of the Paucis Verbis (In a Few Words) e-card series reviews Vasopressors and Inotropes for the Treatment of Shock.

PV Card: Vasopressors and Inotropes in Shock

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Adapted from [1]
Go to ALiEM (PV) Cards for more resources.

Edit 3/28/14: Dopamine removed as second-tier agent for septic shock (mainly reserved for rare cases of inappropriate bradycardia at low risk for arrhythmias)

Reference

Ellender T, Skinner J. The use of vasopressors and inotropes in the emergency medical treatment of shock. Emerg Med Clin North Am. 2008;26(3):759-86, ix. [PubMed]

By Michelle Lin, MD|2021-10-19T18:48:16-07:00Apr 30, 2010|ALiEM Cards, Cardiovascular, Tox & Medications|

What do you do in these cases?

A man on coumadin for atrial fibrillation arrives because he has increased bruising on his skin. He is otherwise asymptomatic. He was told to come to the ED because of a lab result showing INR = 6.
A woman on coumadin for atrial fibrillation arrives because of melena and hematemesis. She looks extremely sheet-white pale. Her vital signs are surprising normal. Stat labs show a hematocrit of 15 and an INR value that the lab is “unable to calculate” because it is so high.

Updated on 6/1/13: Old PV card revised to reflect the 2012 ACCP guidelines

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By Michelle Lin, MD|2017-03-05T14:14:35-08:00Jan 15, 2010|ALiEM Cards, Heme-Oncology, Tox & Medications|

Must-know toxicology website for emergency physicians

With recent discussion about the potential closing of California Poison Control Centers due to budget cuts, I suddenly became shockingly aware of how much Emergency Departments depend on these centers for assistance. They are always so knowledgeable and helpful in managing various ingestions and poisonings.

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By Michelle Lin, MD|2016-11-11T19:01:57-08:00Sep 10, 2009|Tox & Medications|

Article review: Propofol (2007 ACEP Guideline)

Given all the recent brouhaha around propofol and Michael Jackson, I thought I would review the 2007 Annals of EM Clinical Practice Advisory paper on the use of propofol in the Emergency Department for procedural sedation. This is one of the 2009 Lifelong Learning Self-Assessment (LLSA) articles. Each year EM-board certified physicians are tested on 20 pre-selected LLSA articles to maintain eligibility for re-certification.