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Cardiogenic Shock Protocol


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#1 sam1

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Posted 21 April 2010 - 07:13 PM

Currently we are reviewing our protocols for cardiogenic shock. We are going through the various pharmacological agents for use in flight. I am curious as to what other programs are using. I am most interested in the Left sided MI/ Failure patients. We are having some debates about dopamine, dobutamine, levophed, etc and tachy/ hypotensive patients.
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#2 Gila

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Posted 21 April 2010 - 10:24 PM

I'm not sure the current base of evidence can prove the superiority of one agent over another.
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#3 Mike Mims

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Posted 22 April 2010 - 03:08 AM

I agree with Gila...

For us the protocols are:
No pulmonary edema - fluids, 250-500ml bolus'
With pulmonary edema - Dopamine or Dobutamine, with Epi, Norepi and Neosynephrine considered.

However, with TRUE cardiogenic shock we'll consult OLMC for recommendations becasue there is so many other treatment plans that maybe included.
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#4 SerendepitySaki

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Posted 22 April 2010 - 08:48 PM

need more specific questions with regards to the debates. but generally speaking, optimize output while minimizing MVO2. how you accomplish that is debatable. B)

Currently we are reviewing our protocols for cardiogenic shock. We are going through the various pharmacological agents for use in flight. I am curious as to what other programs are using. I am most interested in the Left sided MI/ Failure patients. We are having some debates about dopamine, dobutamine, levophed, etc and tachy/ hypotensive patients.


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LET THE WILD RUMPUS BEGIN !!!!!!
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#5 sam1

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Posted 24 April 2010 - 04:51 PM

need more specific questions with regards to the debates. but generally speaking, optimize output while minimizing MVO2. how you accomplish that is debatable. B)


The specifics are the use of dopamine (which is more of a Chronotrope) versus the use of Dobutamine (which is more of an inotrope). With a patient that is already tachy (hense MVO2 is high), I am very concerned about the use of dopamine as it is written in our protocols. We can always take dobutamine from the sending hospital when possible, but we don't have it in our drug bags on a routine basis.
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#6 SerendepitySaki

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Posted 24 April 2010 - 05:22 PM

classic debate. how perhaps you could post the relevant portions of your protocols w/ their supporting refs (if available) ?

The specifics are the use of dopamine (which is more of a Chronotrope) versus the use of Dobutamine (which is more of an inotrope). With a patient that is already tachy (hense MVO2 is high), I am very concerned about the use of dopamine as it is written in our protocols. We can always take dobutamine from the sending hospital when possible, but we don't have it in our drug bags on a routine basis.


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LET THE WILD RUMPUS BEGIN !!!!!!
Sean G. Smith, RN-Alphabet Soup