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The #icurounds discussion on fluid choice had some great contributions (@petrosoniak, @brambo43, @canibagthat, @RB_cavalcanti, @joshualandy, @ACSmaggus, @rjggoldberg). Seems as though the consensus is initial fluid resuscitation with a crystalloid – normal saline or Ringer’s Lactate.
So let’s go back to our patient, a 75 year old with community acquired pneumonia admitted earlier in the day. Upon reviewing the chart, you find that he’s been resuscitated with 4L of NS to this point.
His pressure is 86/52 with a heart rate of 120, on dopamine 10 mcg/kg/min.
What would you do at this point for pharmacological support of his blood pressure?