This podcast reviews how clinicians should think about patients who's shock isn't responding to our typical management options.
Core EM - Emergency Medicine Podcast Episode 135.0 – Occult Causes of Non-Response to Vasopressors
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Mar 5, 2018 Explore the intriguing challenges of treating hypotensive patients who don’t respond to vasopressors. The discussion dives into vital pathologic factors like metabolic acidosis and myxedema coma. Understand the critical role of swift interventions and the significance of comprehensive patient reassessments. Anaphylaxis management also takes center stage, emphasizing epinephrine's importance and the latest steroid research in critical care. Discover how hypocalcemia can complicate treatment and why rapid ultrasound evaluations are crucial.
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Pause Before Increasing Vasopressors
- Prioritize treating the underlying cause of shock over just increasing vasopressor doses.
- Take a cognitive pause to reconsider diagnosis if high dose pressors do not improve hypotension.
Check and Treat Acidosis
- Check for metabolic acidosis in shock patients not responding to pressors using blood gas and metabolic panel.
- Treat the underlying cause; bicarbonate usually not helpful long term but may bridge to dialysis.
Recognize and Treat Hypothyroidism
- Consider severe hypothyroidism or myxedema coma in refractory shock, especially if physical signs align.
- Empirically treat with levothyroxine without waiting for labs if suspicion is high.
