Review article: Inotrope and vasopressor use in the emergency department

Abstract

Shock is a common presentation to the ED, with the incidence of septic shock increasing in Australasia over the last decade. The choice of inotropic agent is likely dependent on previous experience and local practices of the emergency and other critical care departments. The relatively short duration of stay in the ED before transfer leaves little room for evaluating the appropriateness of and response to the agent chosen. Delays in transfer to inpatient facilities means that patients receive advanced critical care within the ED for longer, requiring initiation and titration of vasoactive agents in the ED. This article discusses the general concepts of shock and the indicators for inotrope and vasopressor use, revises the various agents available and reviews the current evidence for their use.

Transcranial Doppler ultrasound in therapeutic hypothermia for cardiac arrest survivors

“…The SOFA score is based on the assessment of the degree of dysfunction of six vital organ systems: respiratory, cardiovascular, central nervous system, coagulation, liver, and renal (6). The authors may provide the values for each clinical and laboratory parameter included in the SOFA score in this group of patients.…”

Acute heart failure: vasoactive agents – does it matter?

“…The advantage of vasopressin in cardiogenic shock is very questionable. Vasopressin could be useful in cardiopulmonary resuscitation and in the treatment of hyperdynamic (vasoplegic) shock, because its pressor effects are relatively preserved during hypoxic and acidotic conditions (5)(6). Potential adverse effects of vasopressin include excess vasoconstriction causing severe endorgan ischemia and hyponatremia.…”

“…Epinephrine has an unpredictable positive inotropic and vasoconstrictory effect and is a preferred vasoactive agent following cardiac arrest and anaphylaxis (5). It is also used to reverse hypotension with or without bradycardia after cardiopulmonary bypass or cardiac transplantation (6,14).…”

Should reading a journal article really change my practice?

“…Among review articles alone, many fulfil most, if not all, of the precepts in our Mission Statement, such as Robb et al . on the ED implications of the use of the TASER, 9 Holley and Boots on acute severe and near‐fatal asthma, 10 Senz and Nunnink on inotrope and vasopressor use, 11 O'Connor and Walsham on thoracolumbar spine imaging in trauma, 12 Shah et al . on convulsive and non‐convulsive status epilepticus, 13 Isoardi on the limited role of pelvic examination in early pregnancy bleeding, 14 Chong et al .…”