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).
You have just intubated a 4 year old with sepsis from a bad pneumonia. Post intubation BP is 70 systolic, while waiting for the epinephrine (adrenaline) infusion to come up from pharmacy you watch the BP decline into the 60 systolic range and start to use fluids to resuscitate. You are an accomplished adult resuscitationist, and are comfortable mixing, and pushing push dose epi in your adult patients.
The following questions arise as you consider mixing a batch of push dose epi:
How much push dose epinephrine should you give this septic 4 year old?
Do pediatric patients need more or less epi when given in push dose format?
How do some pediatric intensivists and pediatric emergency physicians manage this problem?