nextgen learning to elevate your airway practice
You can stay ahead of the game, if you understand the impact sedation and intubation will have on your hypotensive patient and act to prevent it from happening in the first place.
After listening here, scroll down, or go directly to the content you want using the links below👇
Learn More About Pressors
Start Early & Be Ready with Boluses
For patients in shock who need intubation, don’t delay pressors. Typically, start with an inopressor like norepinephrine and be ready with “push-dose” boluses of epinephrine or phenylephrine post-intubation for sudden pressure drops.
Pressors used during peri-intubation resuscitation have vasoconstrictive and/or inotropic effects. Some inotropes can have vasodilatory effects. Except in extremely select instances, these should never be used in the peri-intubation period.
Norepinephrine is a great all-rounder. It is often called an Inopressor because of its vasopressor and inotropic effects that lead to increased cardiac contractility and peripheral vasoconstriction. Other examples include Epinephrine and Dopamine.
Many institutions and pharmacy policies set limits on pressor rates. Norepinephrine is often set at a maximal dose of 30 mcg/min. Some have pumps that are physically unable to set it higher. There is no physiologic basis for this. Great individual variation occurs in the dose required to attain and maintain adequate blood pressure. In all cases, the dosage should be titrated according to the patient’s response.
At lower doses epinephrine has beta-agonist effects that predominate; with increasing doses it has increasing alpha-agonist effects. This makes it great for bradycardia and cariogenic shock. First-line agent for anaphylactic shock. Another great “push-dose” pressor in the peri-intubation period.
A pure alpha-agonist that causes arterial and venous vasoconstriction. Often given in a “push-dose” for peri-intubation hypotension. Great for vasodilatory shock.
To Be Completed
When you’re ready, it’s time to head to the next poster shown here to continue the journey through this space.
Not in the physical PAC learning space? You can continue to access this enhanced digital content by clicking the link below to advance to the next poster. Otherwise, find the physical poster above for hands-on learning opportunities along with expert coaching in the physical learning space.