Links To EMC’s EM Quick Hits 29 On Vasopressor Failure With Additional Resources

[P0st on causes of functional asplenia. Put resource in the appropriate section.pst [Will be in a later post of qh29. This resource will go in qh29 on asplenic considerations. Functional hyposplenism. 2014 Jan-Mar; 18(1): 7–11. This article has been cited by other articles in PMC.]

In this post, I link to and excerpt from Emergency Medicine Cases’ EM Quick Hits 29 – Vasopressor Failure, Asplenic Considerations, Bronchiolitis Update, ICD Electrical Storm, Night Shift Tips.

*Helman, A. Swaminathan, A. Long, B. Gottlieb, M. Reid, S. Rosenberg, H. Cheskes, L. Morgenstern, J. EM Quick Hits 29 – Vasopressor Failure, Asplenic Considerations, Bronchiolitis Update, ICD Electrical Storm, Night Shift Tips. Emergency Medicine Cases. June, 2021. https://emergencymedicinecases.com/em-quick-hits-june-2021/Accessed 6/24/2021.

I’m posting only the portion from Vasopressor Failure. I will post other sections later. And I include additional resources after the show notes on this topic.

All that follows is from the above show notes.

Topics in this EM Quick Hits podcast

Anand Swaminathan on occult causes of non-response to vasopressors (0:54)

Brit Long & Michael Gottlieb on overwhelming post-splenectomy infection (OPSI) (7:45)

Sarah Reid on a bronchiolitis update and evolving patterns in the COVID era (12:30)

Hans Rosenberg & Lindsay Cheskes on the management of electrical storm and recurrent ICD shocks in the ED (20:43)

Justin Morgenstern on the top 10 evidence-based countermeasures for night shift workers (27:45)

Occult causes of non-response to vasopressors

  • Primary therapy for hypotension is to treat the underlying cause, while initiation of vasopressors is a temporary adjunctive therapy
  • Despite substantial vasopressor doses, some patients may not respond appropriately with improvements in hemodynamic parameters; failure to respond should lead to a cognitive pause and consideration of the occult causes of non-response to vasopressors.

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Occult causes of non-response to vasopressors (source: REBEL EM)

Additional Resources On The Use Of Vasopressors In Shock.

Be sure and review the YouTube video,  Push-Dose Pressors [Epinephrine and Phenylephrine], March 14, 2019 from CORE EM. The video shows you how to prepare syringes of the two medicines.

Every clinician responsible for caring for critically ill patients [even if it is only until the helicopter arrives (critical access hospitals)], needs to review these outstanding resources: Dr. Weingart’s EMCrit and Dr. Farkas’ Internet Book of Critical Care and PulmCrit.

Podcast 87 – Mind of the Resuscitationist: Stop Points
November 26, 2012 by Scott Weingart, MD FCCM. This is my favorite FOAMed resource of all time!

Vasopressors
February 20, 2020 by Josh Farkas from The Internet Book Of Critical Care.  This is an awesome resource.

Septic Shock
February 7, 2017 by Josh Farkas from The Internet Book Of Critical Care.

PulmCrit- Do phenylephrine and epinephrine require central access?
September 7, 2016 by Josh Farkas


Dr. Weingart cautions us that we need to review the two resources below together

EMCrit Podcast 6 – Push-Dose Pressors
July 10, 2009 by Scott Weingart, MD FCCM

EMCrit Podcast 205 – Push-Dose Pressors Update
August 7, 2017 by Scott Weingart, MD FCCM


 

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