The document discusses treatment strategies for septic shock, including:
1) Initial resuscitation targets such as maintaining MAP ≥65 mmHg, CVP 8-12 mmHg, urine output ≥0.5 ml/kg/hr, ScvO2 ≥70%, and SvO2 ≥65%.
2) Hemodynamic management including fluid challenges and use of vasoactive agents like norepinephrine, epinephrine, dopamine, vasopressin, and terlipressin to support blood pressure and tissue perfusion.
3) Evidence that norepinephrine is more effective than dopamine for raising blood pressure in septic shock patients. Epinephrine may be an alternative to
This document discusses septic shock and its management. It covers:
- The pathophysiology of septic shock including absolute and relative hypovolemia, distributive shock, and impaired oxygen extraction.
- The history of managing septic shock from focusing on normalizing blood pressure in the 1960s to measuring oxygen delivery and consumption in later decades.
- Guidelines for initial resuscitation of septic shock patients, including targeting a MAP ≥65 mmHg, CVP of 8-12 mmHg, and ScvO2 ≥70%.
- Use of fluid challenges to guide fluid resuscitation and options for vasopressors like norepinephrine if needed to support blood pressure.
This document summarizes several landmark clinical trials that have impacted emergency medicine practice. It discusses trials regarding the use of tPA for acute ischemic stroke (NINDS, ECASS III), early goal-directed therapy for sepsis (Rivers, Surviving Sepsis), clinical decision rules for cervical spine imaging (NEXUS, Canadian C-Spine Rule), fluid resuscitation (SAFE Trial), use of steroids for Bell's Palsy (Sullivan et al, Berg et al), and CT sensitivity within 6 hours of headache onset for subarachnoid hemorrhage (Perry/Steill et al). Assessment scales for functional outcomes in various conditions are also outlined.
The document discusses two newer anticoagulants, Pradaxa (dabigatran) and Xarelto (rivaroxaban). It summarizes their mechanisms of action, indications, dosing, and monitoring. It notes that neither drug has a proven reversal agent. The summary emphasizes that these drugs are useful for certain patients but have no simple test to measure their effect. It advises that management of bleeding involves resuscitation, treating the source, stopping the drug, and contacting a hematologist, as the drugs cannot be readily reversed due to their short half-lives.
Hyperlipidemia occurs when there are high levels of lipids in the blood. It can lead to the accumulation of lipids in arteries, increasing the risk of cardiovascular diseases like heart attacks, strokes, and peripheral artery disease. Statins are commonly used to treat hyperlipidemia by inhibiting HMG-CoA reductase and reducing cholesterol and ubiquinone levels. Different statins vary in their mechanisms of action, dosages required for efficacy, drug interactions, and side effect profiles. Lifestyle changes and statin therapy aim to lower LDL cholesterol levels according to a patient's risk category to reduce cardiovascular risks.
Hemodynamic Stabilisation In Septic Shockchandra talur
The document discusses hemodynamic stabilization in septic shock. It defines shock and septic shock, and emphasizes that shock requires evidence of inadequate tissue perfusion rather than just hypotension. It then discusses optimizing macrocirculation through fluid resuscitation and vasopressors. It notes that microcirculation and mitochondrial dysfunction are also important in septic shock. Assessment of microcirculation through techniques like orthogonal polarization spectral imaging can provide integrative evaluation of tissue perfusion.
The document discusses several studies comparing different vasopressor agents for the treatment of shock. The SOAP study found no significant difference in mortality between norepinephrine plus dobutamine versus epinephrine alone for septic shock. The CATS study also found no difference in outcomes between these two combinations. The SOAP II trial found no significant difference in mortality between dopamine and norepinephrine for shock, but dopamine was associated with more adverse events. A study by Levy et al. found that norepinephrine-dobutamine for cardiogenic shock had similar hemodynamic effects as epinephrine but with fewer metabolic side effects.
This document summarizes recommendations for vasopressor therapy in sepsis and septic shock. It discusses the pathophysiology of sepsis and progression to septic shock. Early sepsis is characterized by hypovolemia, lactic acidosis, and increased oxygen extraction. Late-stage septic shock involves vasoplegia, reduced stroke volume, microcirculatory failure, and mitochondrial dysfunction leading to multi-organ failure. The document recommends norepinephrine as the initial vasopressor and considers epinephrine, vasopressin, and dobutamine as adjunctive therapies. It cautions against the use of dopamine and phenylephrine based on their adverse effects.
This document discusses septic shock and its management. It covers:
- The pathophysiology of septic shock including absolute and relative hypovolemia, distributive shock, and impaired oxygen extraction.
- The history of managing septic shock from focusing on normalizing blood pressure in the 1960s to measuring oxygen delivery and consumption in later decades.
- Guidelines for initial resuscitation of septic shock patients, including targeting a MAP ≥65 mmHg, CVP of 8-12 mmHg, and ScvO2 ≥70%.
- Use of fluid challenges to guide fluid resuscitation and options for vasopressors like norepinephrine if needed to support blood pressure.
This document summarizes several landmark clinical trials that have impacted emergency medicine practice. It discusses trials regarding the use of tPA for acute ischemic stroke (NINDS, ECASS III), early goal-directed therapy for sepsis (Rivers, Surviving Sepsis), clinical decision rules for cervical spine imaging (NEXUS, Canadian C-Spine Rule), fluid resuscitation (SAFE Trial), use of steroids for Bell's Palsy (Sullivan et al, Berg et al), and CT sensitivity within 6 hours of headache onset for subarachnoid hemorrhage (Perry/Steill et al). Assessment scales for functional outcomes in various conditions are also outlined.
The document discusses two newer anticoagulants, Pradaxa (dabigatran) and Xarelto (rivaroxaban). It summarizes their mechanisms of action, indications, dosing, and monitoring. It notes that neither drug has a proven reversal agent. The summary emphasizes that these drugs are useful for certain patients but have no simple test to measure their effect. It advises that management of bleeding involves resuscitation, treating the source, stopping the drug, and contacting a hematologist, as the drugs cannot be readily reversed due to their short half-lives.
Hyperlipidemia occurs when there are high levels of lipids in the blood. It can lead to the accumulation of lipids in arteries, increasing the risk of cardiovascular diseases like heart attacks, strokes, and peripheral artery disease. Statins are commonly used to treat hyperlipidemia by inhibiting HMG-CoA reductase and reducing cholesterol and ubiquinone levels. Different statins vary in their mechanisms of action, dosages required for efficacy, drug interactions, and side effect profiles. Lifestyle changes and statin therapy aim to lower LDL cholesterol levels according to a patient's risk category to reduce cardiovascular risks.
Hemodynamic Stabilisation In Septic Shockchandra talur
The document discusses hemodynamic stabilization in septic shock. It defines shock and septic shock, and emphasizes that shock requires evidence of inadequate tissue perfusion rather than just hypotension. It then discusses optimizing macrocirculation through fluid resuscitation and vasopressors. It notes that microcirculation and mitochondrial dysfunction are also important in septic shock. Assessment of microcirculation through techniques like orthogonal polarization spectral imaging can provide integrative evaluation of tissue perfusion.
The document discusses several studies comparing different vasopressor agents for the treatment of shock. The SOAP study found no significant difference in mortality between norepinephrine plus dobutamine versus epinephrine alone for septic shock. The CATS study also found no difference in outcomes between these two combinations. The SOAP II trial found no significant difference in mortality between dopamine and norepinephrine for shock, but dopamine was associated with more adverse events. A study by Levy et al. found that norepinephrine-dobutamine for cardiogenic shock had similar hemodynamic effects as epinephrine but with fewer metabolic side effects.
This document summarizes recommendations for vasopressor therapy in sepsis and septic shock. It discusses the pathophysiology of sepsis and progression to septic shock. Early sepsis is characterized by hypovolemia, lactic acidosis, and increased oxygen extraction. Late-stage septic shock involves vasoplegia, reduced stroke volume, microcirculatory failure, and mitochondrial dysfunction leading to multi-organ failure. The document recommends norepinephrine as the initial vasopressor and considers epinephrine, vasopressin, and dobutamine as adjunctive therapies. It cautions against the use of dopamine and phenylephrine based on their adverse effects.
This document discusses types of shock, goals of therapy for different shock states, and vasopressor pharmacology. It defines hypovolemic, cardiogenic, septic, neurogenic, and combined shocks. The goals for hypovolemic shock are to increase preload with fluids, while cardiogenic shock aims to increase cardiac output with drugs like dopamine or dobutamine. Septic and neurogenic shock goals are to first increase preload then increase afterload with vasopressors like norepinephrine, phenylephrine, and vasopressin. Norepinephrine is usually the initial vasopressor, while other drugs like dopamine, epinephrine, vasopressin may be used as adjunct
This document discusses vasopressors and inotropes, including their physiology, principles of use, individual drugs, and complications. It describes the adrenergic receptor subtypes and how drugs like norepinephrine, epinephrine, dopamine, dobutamine, vasopressin, and inamrinone/milrinone act on them. Norepinephrine is the first-line treatment for septic shock while dobutamine is preferred for cardiogenic shock. Potential complications include hypoperfusion, dysrhythmias, local effects, hyperglycemia. The document provides dosing guidelines and discusses implications for septic shock management.
The document defines important terms related to vasoactive drugs and their mechanisms of action. It discusses inotropes, vasopressors, cardiac output, stroke volume, mean arterial pressure, and circulatory shock. It also describes receptors like alpha-1, beta-1, and dopamine D1 receptors. The document provides guidelines for rational use of vasoactive drugs including starting dose, titration, monitoring, and correcting electrolyte imbalances. It also provides methods for calculating dosages of drugs like adrenaline, noradrenaline, and dopamine.
This document provides an overview of inotropes and vasopressors used to support cardiac function. It reviews the physiology of cardiac contraction and classifies drugs by their mechanisms of action on beta-adrenergic, alpha-adrenergic, or phosphodiesterase receptors. Common agents like dopamine, norepinephrine, and vasopressin are described in terms of their hemodynamic effects. The document notes the limited evidence to guide clinical use and suggests choice depends on individual patient factors. Novel approaches combining inotropes with beta-blockers are also mentioned.
Patho Physiology And Icu Management Of Septic Shockchandra talur
1. The document discusses pathophysiology and ICU management of septic shock, outlining definitions of sepsis, SIRS, and progression to septic shock.
2. It describes the microcirculatory dysfunction that occurs in sepsis and importance of optimizing tissue perfusion and oxygen delivery through early goal-directed therapy and hemodynamic support.
3. The case scenario describes a patient in septic shock from perforated abdomen who requires fluid resuscitation, vasopressors, antibiotics and source control according to sepsis management guidelines to stabilize him for emergency surgery.
Surviving Sepsis Campaign
International Guidelines for Management of Severe Sepsis and Septic Shock: 2012
Critical Care Medicine 2013 Feb;41(2):580-637
Positive inotropes, vasopressors, and vasodilatorsAndrew Ferguson
This document contains information about different types of adrenergic receptors, including their location and function. It discusses how agonists act at different receptors and their downstream effects. The receptors are classified into alpha-1, alpha-2, beta-1, beta-2, beta-3, and D1/D2 receptors. The document also provides a table detailing the effects of different drugs on each receptor type.
This document discusses vasoactive agents and their receptor physiology and clinical applications. It begins by outlining the objectives of understanding vasopressor and inotropic receptor physiology and appropriate clinical use. It then provides background on vasopressors, inotropes, and drugs that have both effects. The majority of the document then discusses the receptor physiology and mechanisms of action of various adrenergic, dopaminergic, and vasopressin receptors. It also covers individual drug classifications, effects, indications, and considerations for agents like epinephrine, norepinephrine, dopamine, dobutamine, milrinone, vasopressin, levosimendan, and vasodilators. Studies comparing agents
This document discusses vasopressor and inotropic agents, including their receptor physiology, pharmacological actions, therapeutic uses, and clinical applications. It provides details on commonly used agents like epinephrine, norepinephrine, dopamine, dobutamine, phenylephrine, vasopressin, and milrinone. It explains their effects on hemodynamics like heart rate, contractility, blood pressure, systemic and pulmonary vascular resistance. It also outlines the advantages and disadvantages as well as indications for use in different shock states and heart conditions.
This document summarizes different vasopressors and inotropes used to treat hypotension. It describes the receptor activities, physiological effects, indications, and complications of various drugs including phenylephrine, norepinephrine, epinephrine, dopamine, dobutamine, vasopressin, and phosphodiesterase inhibitors. It provides guidance on selecting agents and titrating doses based on the underlying cause of hypotension and the patient's clinical status.
This document provides an overview of vasopressors and inotropes used in critical care to treat shock. It discusses the different types of shock and principles of resuscitation including fluid administration and optimization of oxygen delivery and consumption. It also reviews the mechanisms of action, indications, and side effects of commonly used vasopressors and inotropes like dopamine, dobutamine, milrinone, levophed, phenylephrine, epinephrine, and vasopressin. Case studies are presented to demonstrate how these agents may be applied based on a patient's hemodynamic status.
1) The document provides information on inotropes and vasopressors including their classification, sites of action, clinical effects, indications, and doses. It discusses catecholamines like adrenaline, noradrenaline, dopamine, and dobutamine. It also covers phosphodiesterase inhibitors, vasopressin, ephedrine, metaraminol, phenylephrine, methoxamine, and digoxin.
2) The document concludes with recommendations on first and second line vasopressor/inotropic agents for different clinical situations like septic shock, heart failure, cardiogenic shock, anaphylactic shock, and anesthesia-induced hypotension.
Rational choice of inotropes and vasopressors in intensive care unitSaneesh P J
The presentation introduces commonly used interpose and vasopressors; their classification; and how to choose the drug in ICU. Clinical scenarios - cariogenic shock; neurocritical care; septic shock and anaphylactic shock are elaborated.
This document discusses inotropes and vasopressors used to support the failing heart or peripheral vasculature. It defines inotropes as drugs that increase cardiac contractility and vasopressors as drugs that induce vasoconstriction. Common inotropes and vasopressors discussed include epinephrine, norepinephrine, dopamine, and dopexamine. It provides details on the physiology and pharmacology of these drugs, including their effects on different adrenergic receptors and cardiovascular functions.
This document provides guidelines for the management of severe sepsis and septic shock according to the Surviving Sepsis Campaign. It outlines the initial resuscitation goals of fluid resuscitation, antibiotic administration, lactate clearance, and maintaining a central venous oxygen saturation of greater than 70% through fluid administration, vasopressors if needed, and dobutamine. The use of stress-dose steroids and recombinant human activated protein C for certain high-risk patients is also recommended.
This document categorizes and describes various cardiac drugs used to treat heart conditions. It lists drug classes including ACE inhibitors, calcium channel blockers, beta blockers, diuretics, vasopressors, and antidysrhythmics. For each drug class, it provides a brief description of the drug's actions, such as its effects on contractility, heart rate, and blood pressure. Side effects are also noted for some classes. The document serves as a reference for nurses on the classifications, uses, and adverse effects of common cardiac medications.
This document discusses the diagnosis and management of shock. It defines shock as impaired tissue oxygenation and perfusion that can lead to organ dysfunction and death if left untreated. The document classifies shock into 4 main categories: hypovolemic, cardiogenic, distributive, and obstructive. It then describes the key clinical features, causes, and goals of treatment for each type of shock. The general principles of shock management are also summarized, which include treating the underlying cause, restoring adequate perfusion and tissue oxygen delivery, and reducing oxygen demand through supportive care.
This document discusses the use of venous blood gas (VBG) analysis as an alternative to arterial blood gas (ABG) analysis in emergency situations. It finds that VBG measurements of pCO2, pH, and bicarbonate correlate well with ABG measurements and are sufficient to guide treatment for conditions like diabetic ketoacidosis. It also finds that a VBG pCO2 level below 45 mmHg can reliably rule out clinically significant hypercarbia. The vast majority of patients can be managed using VBG alone. An ABG is only needed if the VBG results are discordant with the clinical presentation, such as in hemodynamically unstable patients.
1. Perindopril 10 mg po daily is the recommended initial treatment. It is an ACE inhibitor which is recommended as first line treatment for hypertension in patients with diabetes according to guidelines.
2. The patient should be followed up with basic screening including potassium and creatinine levels within one week of starting treatment, then every 3 months to monitor for side effects of the ACE inhibitor such as hyperkalemia and worsening renal function.
3. Additional monitoring of renal function and potassium is needed due to the patient's risk factors of obesity and diabetes which increase
ECMO was used to treat 25 patients with severe cardiogenic shock. The median age was 49 years and 60% were male. The main causes of shock were acute myocarditis (13 patients) and AMI (9 patients). The overall survival rate was 48%. Key findings included significant improvements in MAP, urine output, lactate and SOFA scores in survivors compared to non-survivors during ECMO support. Major complications included bleeding (75%) and infections (16%). The study concluded that VA-ECMO can be an effective treatment for cardiogenic shock, with close monitoring needed to prevent common complications.
This document discusses types of shock, goals of therapy for different shock states, and vasopressor pharmacology. It defines hypovolemic, cardiogenic, septic, neurogenic, and combined shocks. The goals for hypovolemic shock are to increase preload with fluids, while cardiogenic shock aims to increase cardiac output with drugs like dopamine or dobutamine. Septic and neurogenic shock goals are to first increase preload then increase afterload with vasopressors like norepinephrine, phenylephrine, and vasopressin. Norepinephrine is usually the initial vasopressor, while other drugs like dopamine, epinephrine, vasopressin may be used as adjunct
This document discusses vasopressors and inotropes, including their physiology, principles of use, individual drugs, and complications. It describes the adrenergic receptor subtypes and how drugs like norepinephrine, epinephrine, dopamine, dobutamine, vasopressin, and inamrinone/milrinone act on them. Norepinephrine is the first-line treatment for septic shock while dobutamine is preferred for cardiogenic shock. Potential complications include hypoperfusion, dysrhythmias, local effects, hyperglycemia. The document provides dosing guidelines and discusses implications for septic shock management.
The document defines important terms related to vasoactive drugs and their mechanisms of action. It discusses inotropes, vasopressors, cardiac output, stroke volume, mean arterial pressure, and circulatory shock. It also describes receptors like alpha-1, beta-1, and dopamine D1 receptors. The document provides guidelines for rational use of vasoactive drugs including starting dose, titration, monitoring, and correcting electrolyte imbalances. It also provides methods for calculating dosages of drugs like adrenaline, noradrenaline, and dopamine.
This document provides an overview of inotropes and vasopressors used to support cardiac function. It reviews the physiology of cardiac contraction and classifies drugs by their mechanisms of action on beta-adrenergic, alpha-adrenergic, or phosphodiesterase receptors. Common agents like dopamine, norepinephrine, and vasopressin are described in terms of their hemodynamic effects. The document notes the limited evidence to guide clinical use and suggests choice depends on individual patient factors. Novel approaches combining inotropes with beta-blockers are also mentioned.
Patho Physiology And Icu Management Of Septic Shockchandra talur
1. The document discusses pathophysiology and ICU management of septic shock, outlining definitions of sepsis, SIRS, and progression to septic shock.
2. It describes the microcirculatory dysfunction that occurs in sepsis and importance of optimizing tissue perfusion and oxygen delivery through early goal-directed therapy and hemodynamic support.
3. The case scenario describes a patient in septic shock from perforated abdomen who requires fluid resuscitation, vasopressors, antibiotics and source control according to sepsis management guidelines to stabilize him for emergency surgery.
Surviving Sepsis Campaign
International Guidelines for Management of Severe Sepsis and Septic Shock: 2012
Critical Care Medicine 2013 Feb;41(2):580-637
Positive inotropes, vasopressors, and vasodilatorsAndrew Ferguson
This document contains information about different types of adrenergic receptors, including their location and function. It discusses how agonists act at different receptors and their downstream effects. The receptors are classified into alpha-1, alpha-2, beta-1, beta-2, beta-3, and D1/D2 receptors. The document also provides a table detailing the effects of different drugs on each receptor type.
This document discusses vasoactive agents and their receptor physiology and clinical applications. It begins by outlining the objectives of understanding vasopressor and inotropic receptor physiology and appropriate clinical use. It then provides background on vasopressors, inotropes, and drugs that have both effects. The majority of the document then discusses the receptor physiology and mechanisms of action of various adrenergic, dopaminergic, and vasopressin receptors. It also covers individual drug classifications, effects, indications, and considerations for agents like epinephrine, norepinephrine, dopamine, dobutamine, milrinone, vasopressin, levosimendan, and vasodilators. Studies comparing agents
This document discusses vasopressor and inotropic agents, including their receptor physiology, pharmacological actions, therapeutic uses, and clinical applications. It provides details on commonly used agents like epinephrine, norepinephrine, dopamine, dobutamine, phenylephrine, vasopressin, and milrinone. It explains their effects on hemodynamics like heart rate, contractility, blood pressure, systemic and pulmonary vascular resistance. It also outlines the advantages and disadvantages as well as indications for use in different shock states and heart conditions.
This document summarizes different vasopressors and inotropes used to treat hypotension. It describes the receptor activities, physiological effects, indications, and complications of various drugs including phenylephrine, norepinephrine, epinephrine, dopamine, dobutamine, vasopressin, and phosphodiesterase inhibitors. It provides guidance on selecting agents and titrating doses based on the underlying cause of hypotension and the patient's clinical status.
This document provides an overview of vasopressors and inotropes used in critical care to treat shock. It discusses the different types of shock and principles of resuscitation including fluid administration and optimization of oxygen delivery and consumption. It also reviews the mechanisms of action, indications, and side effects of commonly used vasopressors and inotropes like dopamine, dobutamine, milrinone, levophed, phenylephrine, epinephrine, and vasopressin. Case studies are presented to demonstrate how these agents may be applied based on a patient's hemodynamic status.
1) The document provides information on inotropes and vasopressors including their classification, sites of action, clinical effects, indications, and doses. It discusses catecholamines like adrenaline, noradrenaline, dopamine, and dobutamine. It also covers phosphodiesterase inhibitors, vasopressin, ephedrine, metaraminol, phenylephrine, methoxamine, and digoxin.
2) The document concludes with recommendations on first and second line vasopressor/inotropic agents for different clinical situations like septic shock, heart failure, cardiogenic shock, anaphylactic shock, and anesthesia-induced hypotension.
Rational choice of inotropes and vasopressors in intensive care unitSaneesh P J
The presentation introduces commonly used interpose and vasopressors; their classification; and how to choose the drug in ICU. Clinical scenarios - cariogenic shock; neurocritical care; septic shock and anaphylactic shock are elaborated.
This document discusses inotropes and vasopressors used to support the failing heart or peripheral vasculature. It defines inotropes as drugs that increase cardiac contractility and vasopressors as drugs that induce vasoconstriction. Common inotropes and vasopressors discussed include epinephrine, norepinephrine, dopamine, and dopexamine. It provides details on the physiology and pharmacology of these drugs, including their effects on different adrenergic receptors and cardiovascular functions.
This document provides guidelines for the management of severe sepsis and septic shock according to the Surviving Sepsis Campaign. It outlines the initial resuscitation goals of fluid resuscitation, antibiotic administration, lactate clearance, and maintaining a central venous oxygen saturation of greater than 70% through fluid administration, vasopressors if needed, and dobutamine. The use of stress-dose steroids and recombinant human activated protein C for certain high-risk patients is also recommended.
This document categorizes and describes various cardiac drugs used to treat heart conditions. It lists drug classes including ACE inhibitors, calcium channel blockers, beta blockers, diuretics, vasopressors, and antidysrhythmics. For each drug class, it provides a brief description of the drug's actions, such as its effects on contractility, heart rate, and blood pressure. Side effects are also noted for some classes. The document serves as a reference for nurses on the classifications, uses, and adverse effects of common cardiac medications.
This document discusses the diagnosis and management of shock. It defines shock as impaired tissue oxygenation and perfusion that can lead to organ dysfunction and death if left untreated. The document classifies shock into 4 main categories: hypovolemic, cardiogenic, distributive, and obstructive. It then describes the key clinical features, causes, and goals of treatment for each type of shock. The general principles of shock management are also summarized, which include treating the underlying cause, restoring adequate perfusion and tissue oxygen delivery, and reducing oxygen demand through supportive care.
This document discusses the use of venous blood gas (VBG) analysis as an alternative to arterial blood gas (ABG) analysis in emergency situations. It finds that VBG measurements of pCO2, pH, and bicarbonate correlate well with ABG measurements and are sufficient to guide treatment for conditions like diabetic ketoacidosis. It also finds that a VBG pCO2 level below 45 mmHg can reliably rule out clinically significant hypercarbia. The vast majority of patients can be managed using VBG alone. An ABG is only needed if the VBG results are discordant with the clinical presentation, such as in hemodynamically unstable patients.
1. Perindopril 10 mg po daily is the recommended initial treatment. It is an ACE inhibitor which is recommended as first line treatment for hypertension in patients with diabetes according to guidelines.
2. The patient should be followed up with basic screening including potassium and creatinine levels within one week of starting treatment, then every 3 months to monitor for side effects of the ACE inhibitor such as hyperkalemia and worsening renal function.
3. Additional monitoring of renal function and potassium is needed due to the patient's risk factors of obesity and diabetes which increase
ECMO was used to treat 25 patients with severe cardiogenic shock. The median age was 49 years and 60% were male. The main causes of shock were acute myocarditis (13 patients) and AMI (9 patients). The overall survival rate was 48%. Key findings included significant improvements in MAP, urine output, lactate and SOFA scores in survivors compared to non-survivors during ECMO support. Major complications included bleeding (75%) and infections (16%). The study concluded that VA-ECMO can be an effective treatment for cardiogenic shock, with close monitoring needed to prevent common complications.
This document provides guidelines for clinical pharmacy including:
1) Infusion guidelines for various drugs like dopamine, dobutamine, heparin etc with recommended doses and diluents.
2) Common CVS abbreviations used in clinical practice along with their meanings.
3) Maximum recommended daily doses for various drug classes like hypoglycemic agents, antihyperlipidemics, antiplatelets etc.
4) Drug interaction tables listing important interactions between various commonly used drugs.
5) Dosing equivalences for corticosteroids and pediatric antimicrobial dosing guidelines based on renal function.
Pediatric Neuraxial Anesthesia and Postoperative Pain Managementyury
This document discusses neuraxial anesthesia/analgesia benefits such as hemodynamic stability, decreased anesthetic requirements, and improved pain relief compared to IV opioids. It also compares pediatric and adult spine anatomy differences like conus medullaris level and CSF volume. Guidelines are provided for epidural solutions and dosages in children, including maximal bupivacaine bolus and infusion doses. Adjuvants like opioids, clonidine and ketamine are reviewed. Pediatric pain assessment tools and postoperative pain medication options and dosages are also summarized. Case examples demonstrate application of epidural and other analgesic techniques for different pediatric surgical scenarios.
Human: Thank you for the summary. You captured the key points effectively in 3 conc
This document provides summaries of common emergency medications used to treat critical patients. It lists indications, dosages, and considerations for oxygen, epinephrine, atropine, adenosine, amiodarone, dopamine, lidocaine, diltiazem, procainamide, nitroglycerine, magnesium sulfate, and calcium chloride. The document aims to describe the actions and importance of these frequently prescribed critical medications.
This document summarizes a study on the efficacy and safety of using highly concentrated hypertonic saline (HTS) to treat traumatic brain injury (TBI) related refractory intracranial hypertension. The study found that 30% HTS was effective at reducing intracranial pressure in both single and repeated doses without significantly affecting physiological, biochemical, or hematological parameters. The authors concluded that 30% HTS is an effective and safe method for managing refractory intracranial hypertension in TBI patients. However, further research is needed to determine if HTS treatment improves clinical outcomes when used with other therapies.
This document summarizes the post-operative management of patients undergoing pulmonary endarterectomy (PEA) surgery. It discusses strategies for mechanical ventilation and weaning from ventilation. It also covers management of hemodynamics like weaning from inotropes and vasopressors. The document notes potential post-operative complications and their treatment, including reperfusion pulmonary edema, pulmonary hemorrhage, infections, and heparin-induced thrombocytopenia. Effective anticoagulation and monitoring is also emphasized.
Diuretics in hypertension 2015 by Dr Abhishek Rathoredrabhishekbabbu
Diuretics are recommended as first-line therapy for hypertension. The document discusses various classes of diuretics including loop diuretics, thiazides, thiazide-like agents, and potassium sparing agents. It provides examples of drugs in each class, their mechanisms of action, and sites of action. The document summarizes evidence from clinical trials showing that thiazide diuretics like chlorthalidone are more effective than hydrochlorothiazide at reducing cardiovascular events in hypertension. Indapamide is discussed as an alternative to hydrochlorothiazide with similar efficacy and fewer metabolic side effects. Combinations of ACE inhibitors or calcium channel blockers with diuretics are also effective antihy
This document discusses the relationship between kidney disease and cardiovascular disease. It notes that chronic kidney disease (CKD) is an independent risk factor for mortality in patients with coronary artery disease. Even mild elevations in creatinine are associated with increased risk of cardiovascular events. Acute kidney injury, including contrast-induced nephropathy (CIN), is the third leading cause of in-hospital acute renal failure. CIN risk increases with factors like diabetes, older age, decreased kidney function, and higher contrast volume. CIN is linked to worse clinical outcomes like longer hospital stays, increased mortality, and progression to chronic kidney disease. Prevention strategies aim to reduce CIN risk through measures like hydration and medications like sodium bicar
This document discusses drugs used to treat angina pectoris and myocardial infarction. It describes the pathophysiology and types of angina pectoris. The main drug classes discussed are nitrates, calcium channel blockers, and beta blockers. Specific drugs mentioned include nitroglycerin, nifedipine, metoprolol, and propanolol. The mechanisms of action, effects, indications, dosages, and side effects of these drugs are summarized. Risk factor modification and lifestyle changes are also mentioned as important principles in the treatment of angina pectoris.
This document provides information on various emergency drugs including atropine, adrenaline, mephentermine, ephedrine, and xylocard. It describes the class, mechanism of action, indications, dosing, administration, and side effects of each drug. Atropine is an anticholinergic that acts as a competitive muscarinic receptor antagonist. Adrenaline is a direct-acting sympathomimetic that interacts with both alpha and beta receptors to increase heart rate, contractility and blood pressure. Mephentermine and ephedrine are both sympathomimetic amines that cause increased cardiac output through alpha and beta receptor stimulation. Xylocard is a class IB antiarrhythmic sodium channel block
This case presentation describes an 80-year-old female patient admitted to the ICU with a diagnosis of NSTEMI. Her medical history includes diabetes mellitus. On admission, her ECG showed NSTEMI and lab work was notable for elevated WBC and blood sugar. She was started on medications including aspirin, clopidogrel, atorvastatin, ISDN, and insulin. Over her 14-day hospital stay, her medications were adjusted for blood pressure control and management of symptoms like dyspnea and joint pain. Potential drug-drug interactions between her medications including omeprazole and clopidogrel were also assessed.
1. High frequency ventilation (HFV) uses small tidal volumes and high respiratory rates to ventilate patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). HFV aims to recruit and protect the injured lung better than conventional mechanical ventilation (CMV).
2. Two main types of HFV are high frequency oscillatory ventilation (HFOV) and high frequency jet ventilation (HFJV). HFOV uses a piston to displace gas at 180-900 breaths per minute, while HFJV uses gas jets at 240-480 bpm.
3. Early intervention with HFV may improve outcomes compared to using it as a rescue therapy after prolonged CMV fails. Matching the
1) The POPE study was a randomized, double-blind trial that assessed whether the NSAID diclofenac was effective in reducing post-operative pericardial effusion volume compared to placebo.
2) 196 patients with moderate to large pericardial effusions more than 7 days after cardiac surgery were randomized to receive either diclofenac or placebo for 14 days.
3) The primary outcome of mean pericardial effusion grade decrease from baseline to end of treatment showed no significant difference between the diclofenac and placebo groups. Secondary outcomes including late tamponade rates were also similar between groups.
4) The study concluded that NSA
A 2-year-old boy presented with fever, vomiting, and lethargy. He was drowsy, tachycardic, hypotensive, and had a rash. Fluid resuscitation and antibiotics were given. USCOM monitoring showed an initially low cardiac index and high systemic vascular resistance, but improving hemodynamics over time with treatment.
An LC-HRMS method was developed and validated to simultaneously detect and quantify six nitrosamine impurities - NDMA, NDEA, NEIPA, NDIPA, NDBA, and NMBA - in losartan drug substance and drug product at sub-ppm levels. The impurities are separated by reverse phase LC and detected by high resolution MS. Method validation showed it can detect and quantify the impurities from 1.0-100 ng/mL (0.05-5 ppm) with limits of detection from 0.10-0.32 ng/mL (0.005-0.016 ppm). The method provides a tool for testing losartan and potentially other AR
Lecture 1 basic concept on neuroanesthesia 2Sigit Sutanto
1. The document discusses techniques and considerations for neuroanesthesia including maintaining adequate oxygenation and ventilation, controlling intracranial pressure and cerebral blood flow, and using anesthetics and drugs that provide brain protection.
2. Sevoflurane is the preferred inhalational anesthetic due to its effects on cerebral autoregulation and metabolism. Careful extubation is important to avoid spikes in blood pressure.
3. Proper perioperative management including fluid balance, temperature control, and avoidance of increases in intracranial pressure can improve outcomes for patients undergoing neurosurgery.
This document discusses various potential therapies for acute heart failure. It begins by reviewing the historical focus on diuresis, vasodilators, and inotropes from 1970-2010. Currently, over 90% of patients receive intravenous diuretics as the primary treatment. The document then evaluates several promising new treatment approaches that are being studied, including natriuretic peptides, levosimendan, relaxin, soluble guanylate cyclase activators, rolofylline, cardiac myosin activators, and SERCA2a activators. It provides details on clinical trials and mechanisms of action for these novel therapies. Throughout, the document provides a critical look at challenges and limitations for further developing these new
Right atrial pressure as back-pressure for venous returnscanFOAM
A presentation by Per Möller at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All available content from SSAI2017: https://scanfoam.org/ssai2017/
Delivered in collaboration between scanFOAM, SSAI & SFAI.
Similar to Vasopressors in septic shock russie 2012 (20)
This document provides guidelines for the management of severe sepsis and septic shock updated from 2008. A consensus committee of 68 international experts from 30 organizations used the GRADE system to assess evidence quality and determine recommendation strength. Key recommendations include early quantitative resuscitation, blood cultures before antibiotics, prompt broad-spectrum antibiotics, infection source control, initial fluid resuscitation with crystalloids, vasopressor use, glucose control, sedation protocols, stress ulcer and thrombosis prophylaxis, and addressing goals of care. Strong agreement existed among experts regarding many level 1 recommendations to improve patient outcomes.
26. 32 patients randomized : dopamine (Until 25 µg/kg/min)
or norepi ( Until 5 µg/kg/min)
Objective (n=11)
success (n=5) failure : MAP > success (n=15)for failure (n=1)
80 mmHg 6h
10 to 25 µg/kg/min 25 µg/kg/min 1.5±1.2 µg/kg/min 5 µg/kg/min
increase in urine output increase in urine output
decrease in lactate decrease in lactate
10 (n=16)
Norepi (n=16)
Dopasuccess with Dopa + Norepi (25 µg/kg/min +1.7±1.8 µg/kg/min)
Chest 1993, 103:1826-31
27. Dopamine or Norepinephrine ?
93%
69%
P < 0.001
31%
7% p < O.,001
Success Failure Success Failure
Dopamine Norepinephrine
C. Martin et al Chest 1993, 103, 1826
28. Dopamine or Norepinephrine ?
Hyperdynamic septic shock
Dopamine Norepinephrine
(2.5-25 mg (0.5-5.0 mg/kg/min)
/kg/min)
16 patients 16 patients
success : 5/16 (31%) p<0.001 success : 15/16 (93%)
failure : 11/16 failure : 1/16
success : 0/1 success : 10/11
C. Martin et al Chest 1993, 103, 1826
29. Resistance to Dopamine
110 patients
MAP < 70 mmHg with 20 mg/kg/min
60%
P < 0.001
40%
Dopa S Dopa R
Levy et al CCM 2005, 33.
52. Effects of Norepinephrine
on Renal Function
200 250
180
160 200
140
120 150
100 Before NE
Before NE 100 During NE
80 During NE
60 50
40
20 0
Urine Serum Creat
0 flow creat clear
Urine flow Serum creatinine
creat clearance
Martin et al Desjars et al
1990 1989
54. CATS Study
(Epinephrine / norepi-dobu)
Epinephrine Norepi-dobu
n = 161 (n = 169)
Hospital survival Hospital survival
47.8% 51.5%
Power 90% p = 0.51
D. Annane et al Lancet 2007
55.
56. Metaraminol ?
Norepinephrine treated patients switched to
metaraminol (NE : 0.3 + 0.28 µg/kg/min, Meta :
2.5 + 1.7 µg/kg/min)
= MAP = CI
(70/71) (3.7/3.6)
= SvO2
(72/72)
Natalini et al ICM 2005, 31, 634-637
60. a1-AR AC AC
a
b g
a
Gs protein
b g
P P P
Receptor
arrestin
resensitization
clathrin
Receptor endosome Receptor
internalization Receptor degradation
dephosphorylation