There are clinical circumstances when pulse dosing of a pressor may be more appropriate for the patient than beginning an IV pressor infusion. Here are some outstanding resources that speak to this topic. It is really important to go through (watch, read, and review) all of the resources on this blog post to get comfortable with use of this technique. Also remember that much (most?) of the time you will still need to be giving fluid boluses along with the pressors–the resources talk about this aspect also.
I have been going through the complete list of Dr. Larry Mellik Emergency Medicine Videos. All are excellent. I found the video on pulse dosing of epinephrine for hypotension very useful and have embedded that video at the end of this post.
But first, listen to an excellent podcast about pulse dosing of pressors in hypotension from Dr. Scott Weingart from www.emcrit.org titled EM Podcast 6—Push Dose Pressors. Don’t miss all the bonus content on the page. On the page there are printed directions on how to mix epinephrine and phenylephrine for pulse dosing and there also videos showing how to do each mix.
To view Dr. Weingart’s pdf click on mixing instructions for epinephrine and phenylephrine.
Then to assess fluid balance listen to Podcast 86 – IVC Ultrasound for Fluid Tolerance in Spontaneously Breathing Patients. Visit the page and listen to podcast and see the outstanding extra materials including a video on how to assess IVC with US [You can also watch the Assess IVC with US video directly here on Vimeo]. There is also a link to the following abstract: Measuring cardiac index with a focused cardiac ultrasound examination in the ED.
When you have finished the above, then watch Dr. Mellik’s outstanding video:
