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Pressors And Lactic Acidosis

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A discussion of the physiology, pharmacology, and clinical use of vasopressors and inotropes, including phenylephrine, norepinephrine, epinephrine, dopamine, and dobutamine (among others).

Emdocs.net Emergency Medicine Educationan Evidence-based Approach To Pressors In Shock: Part I - Emdocs.net - Emergency Medicine Education

An Evidence-Based Approach to Pressors in Shock: Part I Author: Sarah Brubaker, MD (EM Resident, San Antonio TX) // Edited by: Alex Koyfman, MD (@EMHighAK) and Brit Long, MD (@long_brit) An 86-year-old man with a history of COPD, CHF, CAD, and ESRD presents to your emergency department via EMS for decreased mental status. When he arrives, he is alert but confused, with a rectal temperature of 102.4F, heart rate of 113, and blood pressure of 75/55. You immediately treat for sepsis, administering a fluid bolus, antipyretics, and broad-spectrum antibiotics. However, you think to yourself, What if this patients blood pressure doesnt respond to fluids? When should I give pressors? Which pressors should I use? The evaluation and treatment of patients with cardiovascular shock is a cornerstone of emergency care. Unfortunately, the literature behind the use of vasoactive medications in cardiovascular shock is inconsistent. A Cochrane review in 2004 declared the current available evidence is not suited to inform clinical practice (1). Since 2004, there has been an impressive amount of research to investigate the use and safety of pressors, including several large, multi-center clinical tri Continue reading >>

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Popular Questions

  1. Legerity

    I'm just wondering about people's experience with bad breath on ketosis. Is it really as bad as I've been reading about? I've cut down a lot of carbs although I'm not sure that they are low enough to go into ketosis, but to be honest I think having permanent bad breath would be enough to prevent me from doing so.
    Is this something that goes away or is it just something you have to face on a very low-carb diet? And if you don't have it, does it mean you're not in ketosis?
    Thanks for the information,
    Brian

  2. barehard

    1
    It passes. Stick it out. Don't worry about whether you're in ketosis or not too.

  3. lars1000

    1
    My wife has noticed my "Keto-breath" frequently for the past month. Does it really go away?

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Lactic Acidosis Treatment & Management: Approach Considerations, Sodium Bicarbonate, Tromethamine

Author: Kyle J Gunnerson, MD; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, MCCM more... Treatment is directed towards correcting the underlying cause of lactic acidosis and optimizing tissue oxygen delivery. The former is addressed by various therapies, including administration of appropriate antibiotics, surgical drainage and debridement of a septic focus, chemotherapy of malignant disorders, discontinuation of causative drugs, and dietary modification in certain types of congenital lactate acidosis. Cardiovascular collapse secondary to hypovolemia or sepsis should be treated with fluid replacement. Both crystalloids and colloids can restore intravascular volume, but hydroxyethyl starch solutions should be avoided owing to increased mortality. [ 21 ] Excessive normal saline administration can cause a nongap metabolic acidosis due to hyperchloremia, which has been associated with increased acute kidney injury. [ 32 ] Balanced salt solutions such as Ringer lactate and Plasma-Lyte will not cause a nongap metabolic acidosis and may reduce the need for renal replacement therapy; however, these can cause a metabolic alkalosis. [ 33 ] No randomized, controlled trial has yet est Continue reading >>

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Popular Questions

  1. RustyGainz

    Forevergreen Ketopia products...

    Doing some research about this company popping up on a few of my facebook keto groups. This product claims to shorten the week long Keto transformation process into a couple of hours. I've done some research and got an ingredients list of one of the products and plan to do some digging on the ingredients but just decided to check here in the meantime to see if anyone knew anything about these products weather they are completely useless, dangerous, or...
    I am pretty skeptical about this product but would like to find some evidence to prove to people why it should not be relied on.

  2. JonBana

    Originally Posted by RustyGainz
    Doing some research about this company popping up on a few of my facebook keto groups. This product claims to shorten the week long Keto transformation process into a couple of hours. I've done some research and got an ingredients list of one of the products and plan to do some digging on the ingredients but just decided to check here in the meantime to see if anyone knew anything about these products weather they are completely useless, dangerous, or...
    I am pretty skeptical about this product but would like to find some evidence to prove to people why it should not be relied on.

    Supplements will tell you anything to sell a product look at simple carb supplemtns .. enough research to say we don't need them post workout but yet companys push them and people still buy them because they believe in advertising , slow and steady wins every time , theres no magic pill

  3. JerryB

    My conclusions on the website was it's another network marketing scheme.

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This Wisconsin Critical Care Paramedic module covers vasopressors and inotropes in the pharmacotherapy of shock as associated with critical care interfacility transports.

Approach To Hemodynamic Shock And Vasopressors

Approach to Hemodynamic Shock and Vasopressors Departments of *Nephrology and General, Visceral and Transplant Surgery, University Hospital, University Duisburg-Essen, Essen, Germany; and Critical Care Medicine and Nephrology, George Washington University Medical Center, Washington, DC Dr. Stefan Herget-Rosenthal, Klinik fr Nieren- und Hochdruckkrankheiten, Universittsklinikum Essen, Universitt Duisburg-Essen, Hufelandstrasse 55, D-45122 Essen, Germany. Phone: +49-201-723-2552; Fax: +49-201-723-5633; E-mail: stefan.herget-rosenthal{at}uni-due.de Hemodynamic shock (HS) is a clinical syndrome that is commonly observed in hospitalized patients. Prompt recognition and intervention are the cornerstones of mitigating the dire consequences of HS. Untreated HS usually leads to death. Unlike other types of clinical syndromes (e.g., chest pain), for which a clinical diagnosis is made before treatment is initiated in earnest, the treatment of shock often occurs concurrently or ahead of the diagnostic process. The maintenance of end-organ perfusion is critical to prevent irreversible organ injury and failure, and this frequently requires the use of fluid resuscitation and vasopressors. A comp Continue reading >>

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  1. Anguscollegekid

    What exactly is acidosis, how does it occur and what determines if they live or quick death?

  2. milkmaid

    Good grief... there's no such thing as a short answer to that question. Best suggestion would be to run a search on the boards and/or on google before asking here.
    My very concise answers to your questions... acidosis is a state where the pH of the animal's rumen and/or body organs, blood, etc, drop below normal levels to an acidic pH. Usually caused by grain overload, can also be caused by diarrhea (loss of electrolytes). As with any problem, the level of severity and prompt treatment determine the outcome.

  3. 1982vett

    I find this to be a pretty good source of information.
    http://www.merckvetmanual.com/mvm/index ... d=acidosis

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