Wednesday, January 6, 2016

Push-dose Pressors

emDocs - Jan 4, 2014 - By Brendon Browning
"Recap Basics
Indications for push-dose pressors include transient hypotension — when the clinician anticipates that the patient’s blood pressure will improve if given some time — but the current blood pressure is dangerously low, as may occur post-intubation or during procedural sedation. Another indication is as a temporizing measure until a central line can be placed, infusion vasopressors can be mixed up and received, or patient adequately resuscitated with crystalloid fluids.
Bottom Line/Pearls & Pitfalls
  • Ensure you use the correct dosage of epinephrine.
  • Do not bolus cardiac arrest doses of epinephrine (1:10,000) unless the patient is pulseless.
  • The concentration of push-dose epinephrine, properly mixed up, will be the same as that contained in lidocaine preparations used in local analgesics — 1:100,000. Knowing this, if the push-dose epinephrine were to extravasate, it would be equivalent to injecting 0.5-2 mL of lidocaine with epinephrine subcutaneously."
EMCrit Podcast 6 – July 10, 2009 by scott Weingart / Updated 2015
"Bolus dose pressors and inotropes have been used by the anesthesiologists for decades, but they have not penetrated into standard emergency medicine practice. I don’t know why. They are the perfect solution to short-lived hypotension, e.g. post-intubation or during sedation.
They also can act as a bridge to drip pressors while they are being mixed or while a central line is being placed."

In this video we demonstrate how to use pulse doses of diluted epinephrine to support the blood pressure of a hypotensive patient.