Critical Care Fundamentals: Management of Shock Part 2A

Shock is defined as circulatory failure leading to decreased organ perfusion.  In a shock state there is an inadequate delivery of oxygenated blood to tissues that results in end-organ dysfunction.  Effective resuscitation includes rapid identification and correction of inadequate circulation.  the finding of normal hemodynamic parameters (i.e. normal blood pressure) doe not exclude shock itself.  In this 15 minute and 46 second video, I will review the management shock – part 2a (Norepinephrine, Epinephrine, Dopamine, Phenylephrine, and Push-Dose Pressors).

[embedyt] https://www.youtube.com/watch?v=rrgWc9kwb-4[/embedyt]

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References:

1. Sharshar T et al. Circulating Vasopressin Levels in Septic Shock. Cris Care Med 2003; 31(6): 1752 – 8. PMID: 12794416
2. Russell JA et al. Vasopressin Versus Norepinephrine Infusion in Patients with Septic Shock. NEJM 2008; 358(9): 877 – 87. PMID: 18305265
3. Chawla LS et al. Intravenous Angiotensin II for the Treatment of High-Output Shock (ATHOS Trial): A Pilot Study. Crit Care 2014; 18(5): 534. PMID: 25286986
4. De Backer D et al. Comparison of Dopamine and Norepinephrine in the Treatment of Shock. NEJM 2010. PMID: 20200382
5. Ventura AM et al.Double-Blind Prospective Randomized Controlled Trial of Dopamine Versus Epinephrine as First-Line Vasoactive Drugs in Pediatric Septic Shock. Crit Care Med 2015. PMID:26323041
6. Permpikul et al. Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER): A Randomized Trial. AJRCCM 2019. PMID: 30704260
7. Gordon AC et al. Effect of Early Vasopressin vs Norepinephrine on Kidney Failure in Patients With Septic Shock: The VANISH Randomized Clinical Trial. JAMA 2016. PMID: 27483065
8. Annane D. et al. Norepinephrine plus dobutamine versus epinephrine alone for management of septic shock: a randomised trial. Lancet 2007. PMID: 17720019
9. Myburgh JA et al. Comparison of epinephrine and norepinephrine in critically ill patients. Intensive Care Med. 2008. PMID: 18654759

Critical Care Education Curriculum

Please watch Critical Care Fundamentals – Mgmt of Shock Part 1 & Mgmt of Shock Part 2B as well

Mgmt of Shock – Educational Reinforcement Material

Mgmt of Shock – Supplemental Educational Material

Post Peer Reviewed By: Salim R. Rezaie, MD (Twitter: @srrezaie)