A Push for Push Dose Epinephrine

You transport a 79-year-old woman to the hospital for fever and urinary incontinence. Her family mentions a history of frequent urinary tract infections. Her initial vital signs are a heart rate of 115 bpm, an oxygen saturation of 97% on room air, and a blood pressure of 105/75 mmHg. You establish a peripheral IV line and begin a bolus of normal saline. About 15 minutes away from the hospital, you note the patient becomes increasingly drowsy. Her heart rate has increased to 125 bpm and her blood pressure is now 85/47 mmHg. What are your next steps? Prehospital Shock Starting in 2018, push dose epinephrine replaced dopamine as the vasopressor of choice for the management of prehospital shock in Alameda County, California.1 For the EMS system, properly managing shock is critically important as it’s both common and life-threatening. One meta-analysis showed the prevalence of non-traumatic hypotension (systolic blood pressure [SBP] < 90 mmHg) to be around 2%. However, these patients had an in-hospital mortality between 33–52%.2 The empiric treatment of shock in the prehospital setting is difficult because of the multiple etiologies that lead to the final common pathway of decreased perfusion.3 In Alameda County, prehospital personnel treat according to suspected type of shock: anaphylactic, traumatic/hemorrhagic, septic, hypovolemic or cardiogenic.1 Move to Epinephrine For years, dopamine has been the first-line vasopressor for EMS, but a growing body of evidence has suppo...
Source: JEMS Patient Care - Category: Emergency Medicine Authors: Tags: Training Cardiac & Resuscitation Top Story Exclusive Articles Patient Care Source Type: news