Case 1.. back to the pressor.

Thank you and welcome to all the followers through WordPress, Twitter, and Facebook over the past week.

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?

Case 1: A pressing issue…

A 75 year old patient is brought to the ICU from the general medicine ward with hypotension. He was admitted a few hours earlier with community acquired pneumonia but had progressive hypotension. He was started on dopamine at 10 mcg/kg/min and currently has a blood pressure of 86/52 with a heart rate 120 on the floor and on arrival to the unit, you’re asked whether you are happy with dopamine or if you would like to switch to another “pressor”?

What are your thoughts on choice of pharmacological support in this patient with septic shock?