Running from a Bear: How We Teach Vasopressors, Adrenoreceptors, and Shock

Abstract

Vasopressors are widely used in the management of shock among critically ill patients. The physiology of vasopressors and adrenoreceptors and their effects on end organs therefore represent important, high-yield topics for learners in the critical care environment. In this report, we describe our approach to teaching this core concept using the stereotypical human physiologic response when running from a bear, in the context of the relevant supporting literature. We use escaping from a threatening predator as a lens to describe the end-organ effects of activating adrenoreceptors together with the effects of endogenous and exogenous catecholamines and vasopressors. After reviewing this foundational physiology, we transition to the clinical environment, reviewing the pathophysiology of various shock states. We then consolidate our teaching by integrating the physiology of adrenoreceptors with the pathophysiology of shock to understand the appropriateness of each therapy to various shock phenotypes. We emphasize to learners the importance of generating a hypothesis about a patient’s physiology, testing that hypothesis with an intervention, and then revising the hypothesis as needed, a critical component in the management of critically ill patients.

Rethinking Vasopressor Education: The Need to Avoid Teaching the Bare Minimum

“…However, the educational content (the “what”) must be sufficiently comprehensive to capture both key physiological concepts and relevant supporting data for those concepts. Although the educational format described in this brief review ( 1 ) is excellent, we believe the authors erred in their exclusion of angiotensin II and the renin-angiotensin-aldosterone system (RAAS).…”

Reply to: Rethinking Vasopressor Education: The Need to Avoid Teaching the Bare Minimum

“…We thank McCurdy and Busse for their thoughtful letter in response to our teaching approach ( 1 ). We emphatically agree with the importance of the renin-angiotensin-aldosterone system (RAAS) in human evolutionary physiology and the role of angiotensin II in the management of refractory shock.…”