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In this podcast, the concept of vasopressor use in hemorrhagic shock is discussed. Key take away points:
- US and UK literature is much less supportive of vasopressor use in hemorrhagic shock than continental European literature.
- Concept is while filling the tank with blood, getting some squeeze in the venous system to keep it circulating.
- If a young trauma patient has cool extremities, they are already vasogenic and unlikely to benefit from vasopressors. Warm extremities mean they may benefit from vasopressors.
- Norepinephrine is the drug of choice. Aim for a maintenance dose of 3-5 mcg/min and no need to titrate because you are not looking for arterial constriction, just venous tone.
- Low dose Vasopressin drip may be beneficial as well, however more literature is needed.
- Blood is still the answer in these patients! Vasopressors are an adjunct to creating a balanced resuscitation.
References
https://emcrit.org/emcrit/vasopressors-for-hemorrhage/