Episode 8: Vasopressors

In this episode, Dr Elizabeth Tan and Dr Lenard Cheng interview Dr Tallie Chua about Vasopressors. We discuss a recent article published in The Journal of Emergency Medicine 2024 entitled: A Clinical Review of Vasopressors in Emergency Medicine. 

Timestamps

• 02:03 Case Scenario (Hypothetical) 
• 05:52 Hypovolemic Shock
• 07:04 CENSER
• 08:14 CLOVERS
• 09:23 SOAP II 
• 09:43 Second line Vasopressors 
• 10:54 Peripheral vasopressors
• 16:37 Push Dose pressors 
• 20:14 Optimal MAP
• 22:29 Cardiogenic Shock 
• 26:10 Obstructive Shock 
• 28:37 Vasopressor unresponsive shock - PACT
• P = pH (acidosis)
• A= adrenal insufficiency
• C = hypocalcemia
• T - Hypothyroidism

References

1. Stampfl M, DeBlieux P. A Clinical Review of Vasopressors in Emergency Medicine. J Emerg Med. 2024 Jul;67(1):e31-e41. doi: 10.1016/j.jemermed.2024.03.004. Epub 2024 Mar 12. PMID: 38789351.
2. Permpikul C, Tongyoo S, Viarasilpa T, Trainarongsakul T, Chakorn T, Udompanturak S. Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER). A Randomized Trial. Am J Respir Crit Care Med. 2019 May 1;199(9):1097-1105. doi: 10.1164/rccm.201806-1034OC. PMID: 30704260.
3. National Heart, Lung, and Blood Institute Prevention and Early Treatment of Acute Lung Injury Clinical Trials Network; Shapiro NI, Douglas IS, Brower RG, Brown SM, Exline MC, Ginde AA, Gong MN, Grissom CK, Hayden D, Hough CL, Huang W, Iwashyna TJ, Jones AE, Khan A, Lai P, Liu KD, Miller CD, Oldmixon K, Park PK, Rice TW, Ringwood N, Semler MW, Steingrub JS, Talmor D, Thompson BT, Yealy DM, Self WH. Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension. N Engl J Med. 2023 Feb 9;388(6):499-510. doi: 10.1056/NEJMoa2212663. Epub 2023 Jan 21. PMID: 36688507; PMCID: PMC10685906.
4. De Backer D, Biston P, Devriendt J, Madl C, Chochrad D, Aldecoa C, Brasseur A, Defrance P, Gottignies P, Vincent JL; SOAP II Investigators. Comparison of dopamine and norepinephrine in the treatment of shock. N Engl J Med. 2010 Mar 4;362(9):779-89. doi: 10.1056/NEJMoa0907118. PMID: 20200382.
5. Hawn JM, Bauer SR, Yerke J, Li M, Wang X, Reddy AJ, Mireles-Cabodevila E, Sacha GL. Effect of Phenylephrine Push Before Continuous Infusion Norepinephrine in Patients With Septic Shock. Chest. 2021 May;159(5):1875-1883. doi: 10.1016/j.chest.2020.11.051. Epub 2020 Dec 13. PMID: 33316239. 

Credits

Music: Life-line by Colorful Sound via Pixabay/Best Day by OctoSound via Pixabay 

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Chapters

• 2:03 Case Scenario (Hypothetical)
• 5:42 Hypovolemic Shock
• 7:42 CENSER trial
• 8:14 CLOVERS trial
• 9:23 SOAP II
• 9:43 Second line Vasopressors
• 10:54 Peripheral vasopressors
• 16:37 Push Dose Pressors
• 20:14 Optimal MAP
• 22:29 Cardiogenic Shock
• 26:10 Obstructive Shock
• 28:37 Vasopressor unresponsive shock - PACT