i wonder which inotropic drug is 1st choice in critical patients with hypovolemic shock? please tell us the right dose & infusion rate. the available drugs we have here are only dopamine and adrenaline.
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In the event of hypovolemic shock I would suggest adrenaline as a very short term supportive measure only. The treatment for hypovolemic shock is generally restoring circulating volume although if you're dealing with a surgical situation like trauma or a ruptured aortic aneurysm then volume should only be restored to the minimum required to maintain perfusion until surgical control of bleeding is accomplished. |
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As posted by Brad, the treatment of hypovolemic shock is restoring circulating volume. However, there are few situation where you will have to temporize patient until one is able to do so or delay restoring circulating volume until other issues are corrected: 1-Trauma patients with significant blood loss, should be under resuscitated and temporized with pressers until the source of bleeding is controlled. This is simply to avoid massive transfusions with all the immunosuppressive and coagulopathy complications. This have been shown in multiple studies. The same apply to OR patients, say undergoing ruptured AAA repair, Where IV access is established, capacity to infuse large volumes is assured but not normalize circulating volume and restore normal blood pressure until the Aorta is clamped. 2-If one is waiting on blood or blood product to arrive or become available. Now what agent? Patients with healthy hearts and no risk of CAD, any pressor or inotrpe will do as tachycardia is not of great concern with normal Coronary blood flow. However for patients who are at risk of ischemia, Alpha agonists are preferred over epinephrine for the short term. Doing so, will restore perfusion pressure to vital organs while adding less stress on a strained myocardium. Norepinephrine 0.05 to 0.3 ug/kg/min Epinephrine 0.05 to 0.4 ug/kg/min Just remember that this is an average doses but really there are no maximum doses References: Immediate versus Delayed Fluid Resuscitation for Hypotensive Patients with Penetrating Torso Injuries William H. Bickell, Matthew J. Wall Jr., Paul E. Pepe, R. Russell Martin, Victoria F. Ginger, Mary K. Allen and Kenneth L. Mattox N Engl J Med 1994; 331:1105-1109October 27, 1994 |
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