VasopressorPhenylephrine is sometimes used as a vasopressor to increase the blood pressure in unstable patients with hypotension. Such use is more common in anesthesia or critical-care practices; phenylephrine is especially useful in counteracting the hypotensive effect of epidural and subarachnoid anesthetics. It also has the advantage of not being inotropic or chronotropic, and so it strictly elevates the blood pressure without increasing the heart rate or contractility (reflex bradycardia may result from the blood pressure increase, however). This is especially useful if the heart is already tachycardic and/or has a cardiomyopathy.http://en.wikipedia.org/wiki/Subarachnoid
Pmn – Mean pressure gradient across the aortic valve (mmHg)Is dependent upon the flow.Pmn Normal upper limit = 2mmHg per litre of CI.
Case Study - Adult - Pneumonia - Septic Shock
Pneumonia - Septic Shock Presentation 42 y/o male BP 102/41 CVP 10 Initial Diagnosis Pneumococcal pneumoniawww.uscom.com.au The Measure of Life
Pneumonia - Septic Shock BP 102/42 (61) CI 9.3 HR 129 SVR 215www.uscom.com.au The Measure of Life
Pneumonia - Septic Shock Treatment Minimal fluid needed as it will only make his lungs wetter. Vasoconstrictor (phenylephrine) "Do you think he needs the vasoconstrictor?” "Do you think he needs to go to ICU?" Summary Legionaires disease with septic shock! Conclusion USCOM helped with rapid measurement and recognition of the hyperdynamic circulation and confirmed appropriate treatment.www.uscom.com.au The Measure of Life
Aortic Stenosis? How can I know when a high CO/CI is due to Aortic Stenosis and not a Hyperdynamic Circulation such as Septic Shock? On Echocardiogram, Pmn(mmHg) is used to calculate the mean pressure gradient across a valve. < 25mmHg = Mild Aortic Stenosis But Pmn is dependent upon the flow. Normal upper limit = 2mmHg per litre of CI. In a normal adult circulation CI 2.4-4.2, Pmn usually <9 In our high CO state of CI 9.3, Pmn =13mmHg <19mmHg = not Aortic Stenosiswww.uscom.com.au The Measure of Life