An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
Which should be the first-line vasopressor between norepinephrine and epinephrine in cardiogenic shock?Your patient had an MI and is now in cardiogenic shock.They are hypotensive and need a vasopressor.To clarify, The Crit Doc of Tik Tok aka CriticalCareNow aka Haney Mallemat likes epinephrine as an inotrope, not a vasopressor.This was a pilot study, meaning that …
Continue reading Norepinephrine or Epinephrine in Cardiogenic Shock: Is One Better?
Is your institution a milrinone shop or a dobutamine shop? Or do you have a mixed shop?It seems that most institutions are accustomed to use mostly one or the other in cardiogenic shock.Some argue that milrinone is better.Some argue that dobutamine is better.But do we know the answer?This was answered late in 2021 in the …
Continue reading Milrinone or Dobutamine in Cardiogenic Shock?
I have quite the love-hate relationship with central lines. They sometimes give me the warm and fuzzies when my Emergency Medicine colleagues call me for a sick patient in the ED who is completely appropriate for the ICU and I see a right internal jugular central venous catheter on the chest x-ray. In my practice, …
Continue reading Peripheral Vasopressors: Are They Safe for our Patients?
Midodrine (brand name Proamatine), is an alpha-1 adrenergic agonist that is orally administered. It is used in both in the outpatient setting as well as inpatient setting to restore vascular tone and increase blood pressure. One of the benefits of this medication in the Intensive Care Unit (ICU) is that we can administer it to …
The intention of this post is going to be to take a deep dive into the states of vasopressors using the best evidence based practices available. It will be routinely updated. This is a work-in-progress blog post on vasopressors. Last updated 02/25/2022.If you find this blog post useful, and you want to cite it in …
This is one sexy pilot study about norepinephrine in cardiogenic shock. The authors here decided to take a look at norepinephrine (NE) versus epinephrine in patients with cardiogenic shock s/p MI. They didn't use dopamine as they had noted an article that I have reference here where I discussed how dopamine actually increases mortality in …
Continue reading Norepinephrine vs. Epinephrine in AMI Cardiogenic Shock
This is a question that is often asked. Do we give fluids until the patient no longer "responds to fluids" or start vasopressors early? Should we start early vasopressors in septic shock or wait until fluids resuscitation is complete?Here's my bias: I dislike arbitrarily pounding patients with fluids. It causes harm. We know this. I …
I’ve said this on numerous occasions and I’ll repeat it again. I do not do research. I have one study published and that’s because I needed to do it to complete fellowship. Outside of that, I’m a boot on the ground doc. I feel bad criticizing but here we are regarding angiotensin II/Giapreza. Now that …
Continue reading Angiotensin II/ Giapreza in Vasodilatory Shock
Does your friendly neighborhood cardiologist or intensivist start your Cardiogenic Shock patient on dopamine? Do you ever ask them when was the last time they read a study? I don’t mean to be harsh but this data is now almost a decade old. This study placed dopamine far down on the vasopressor selection totem pole. …
Continue reading Dopamine for Cardiogenic Shock: Shown to Increase Mortality.
I don’t know about you all but I’m constantly working on finding new ways to treat my septic shock patients who, based on the numbers from larger studies, have a mortality rate between 25-35%. I have used methylene blue on various occasions for post-CPB vasoplegia but would it possibly work in septic shock? UPDATE: This …
