Vasopressors

Background

The goal of vasopressor use is to reach critical organ perfusion pressure. Estimated required mean arterial pressures (MAP) are listed below. It is generally safe to aim for a goal map of 65 mmHg. Vasopressors also promote increased venous return.

• Brain: MAP of 50 mmHg
• Heart: MAP of 65 mmHg
• Kidneys: MAP 65-75 mmHg

IV Vasopressor have not been shown to be unsafe when used peripherally If running peripherally perform frequent site check via institutional protocol.

Push Dose Pressors

• Use when need temporary BP or CO boost
  • Post-intubation hypotension
  • Propofol-induced hypotension
  • A-fib w/ hypotension
    • Easier to convert well-perfused heart

Epinephrine

• Mix 9mL of NS with 1mL of 1:10,000 epi
  • Now have 10mL of 10mcg/mL
    • Use 0.5-2mL q2-5min (similar to epi drip)
    • Same as 2% lido with epi
      • Ok to give peripherally
• Onset - 1min
• Duration - 5-10min

Phenylephrine

• Pure alpha (no effect on heart)
• Place 1mL of 10mg/mL vial in 100mL NS
  • Now have 100mcg/mL
  • Draw up 10mL
  • Use 0.5-2mL q2-5min (50-200mcg)
• Onset - 1min
• Duration - 20min

Source

• EmCrit Podcast 6