Circulatory support procedure
- Cardiac monitoring; obtain 12-lead ECG and treat dysrhythmias as appropriate.
- IV/IO access
- Fluid Resuscitation
- Medication administration (if persistent hypotension despite adequate fluid administration, to temporarily stabilize blood pressure until vasopressor infusion can be initiated.)
Fluid Resuscitation
Fluid Bolus:
* Adult: 500 mL, repeat PRN to meet target BP goals
* Pedi: 20 mL/kg, repeate PRN to meet target BP goals.
Titrate to target BP goals:
* TBI/Stroke: >= 110 mm Hg
* Blunt trauma: = 100mm Hg
* Hemorrhagic Shock or Penetrating Trauma: SBP = 90 mm Hg (max 500 mL)
Other patients:
* Adult (MAP): >= 65 (or SBP >= 90mm Hg if manual measurement
* Pedi (SBP): 70mm Hg + (age in years x2) or >= 90 mm Hg for age 10 or greater.
Epinephrine (Adrenalin, Epipen)
Description: A medication used in the emergency treatment of allergic reactions and for the treatment of high levels of pressure in the eye (glaucoma) as well as asthma.
Therapeutic Categories: Adrenergic Alpha-Agonists, Adrenergic Beta-Agonists, Catecholamines, Sympathomimetic (Adrenergic) Agents
Summary:
Epinephrine is a hormone and neurotransmitter used to treat allergic reactions, to restore cardiac rhythm, and to control mucosal congestion, glaucoma, and asthma.
Usage: pinephrine injection and nasal spray are indicated in the emergency treatment of type I allergic reactions, including anaphylaxis. Epinephrine injection is also used to increase mean arterial blood pressure in adult patients with hypotension associated with septic shock.
Epinephrine’s cardiac effects may be of use in restoring cardiac rhythm in cardiac arrest due to various causes but is not used in cardiac failure or in hemorrhagic, traumatic, or cardiogenic shock
Dosage:
* Epinephrine (push dose): (0.1 mg in 10 mL NS) Adult: 10 mcg (1 ml) IV/IO, repeat q 5-minutes PRN, max total dose 50 mcg (5 ml); Pedi: 1 mcg/kg (max single dose 10 mcg), repeat q 5-minutes PRN, max total dose 50 mcg (5 ml)
If suspected anaphylaxis/anaphylactic shock or symptomatic bradycardia
- Epinephrine (infusion): (1 mg 1:10,000 / 250 mL NS or 1 mg 1:1,000/250 mL NS; 4 mcg/mL) Adults: start at 5 mcg/min, titrate to goals above; Pedi: start at 0.1 mcg/kg/min, titrate to goals above.
Norepinephrine (Levophed)
Description: A medication used to treat life-threatening low blood pressure or shock.
Therapeutic Categories: Alpha-and Beta-adrenergic Agonists, Catecholamines
Summary: Norepinephrine is a sympathomimetic used in the control of blood pressure during various hypotensive states and as an adjunct treatment during cardiac arrest.
Indication: Norepinephrine is a sympathomimetic used in the control of blood pressure during various hypotensive states and as an adjunct treatment during cardiac arrest.
Dexamethasone (Decadron)
Description: A medication used to treat inflammatory conditions in various body locations, as well as asthmatic conditions.
Therapeautic Categories: Anti-Inflammatory Agents, Corticosteroids
Summary: Dexamethasone is a glucocorticoid available in various modes of administration that is used for the treatment of various inflammatory conditions, including bronchial asthma, as well as endocrine and rheumatic disorders.
Indication: If septic shock with vasopressor infusion or documented history of Addison disease/adrenal insufficiency
Description: A medication used in emergencies to increase blood pressure.
Therapeutic Categories: Vasoconstrictor Agents
Summary:
Vasopressin is a peptide hormone used to increase blood pressure in patients with vasodilatory shock who are resistant to fluid and catecholamine therapy.
Indications: Vasopressin is indicated to increase blood pressure in adults in vasodilatory shock refractory to the application of fluids and catecholamines.
Description: A medication used to treat serious cases of low blood pressure, often during surgery when anesthesia is used and leads to low blood pressure.
Therapeutic Categories: Adrenergic Agonists, Sympathomimetic Agent, Vasoconstrictor Agents
Summary: Phenylephrine is an alpha-1 adrenergic agonist used in the management of hypotension, generally in the surgical setting associated with the use of anesthetics.
Indications: Phenylephrine is available in various drug formulations, which have different indications. Phenylephrine injections are indicated to treat hypotension caused by shock or anesthesia. The ophthalmic formulation is indicated to induce mydriasis and conjunctival vasoconstriction. The intranasal formulation is used to treat congestion, and a topical formulation is used to treat hemorrhoids. Off-label uses include priapism and induction of local vasoconstriction.
