Vasodilators

Vasodilators

1. Nitroglycerine (Tridil) & Nitroprusside (Nipride)

2. reduce preload (pressure when blood into heart- ↓ pressure) & afterload (heart has to pump against aorta), ↓O₂ demand of the heart

3. disadvantage: cause hypotension

4. given with cardiogenic shock

5. given with dopamine or dobutrex helps maintain BP

Vasoconstrictors (not used much) short-term, problem maintaining BP, will ↑BP

1. Norepinephrine (Levophed), Phenylephrine (Neo-Synephyrine), Vasopressin (Pitressin)

2. increase BP by vasocontriction

3. disadvantage: ↑afterload, thereby ↑workload of heart, compromise perfusion to skin, kidneys,

lungs, GI tract.

Other meds Lemone 277

1. diuretics ↑UO only when fluid replacement adequate

2. sodium bicarb – buffer

3. calcium

4. antiarrhythmics

5. broad-spectrum antibiotics – all invasive procedures

6. cardiogenic glycosides

7. corticosteroids

8. morphine

9. oxygen by mask, canula

10. Oxygen for 4-6 hrs then oxygen P0₂ 80 (best 90) perfusion 85. on ventilator if too low

Nutritional Support – need 3000 cal / day, will burn muscle in shock, helps GI to have food run thru it

1. Parenteral

2. Enteral – if in shock long time

   glutamine – ess. amino acid in stress – immunologic function in GI tract. fuel for lymphocytes

3. Stress ulcers – must be on something

a. H₂ inhibitors – pepcid, zantac

b. proton pump inhibitors - prevacid

Hypovolemic – lemone 273

1. caused by a ↓in circulating volume of 15% or greater (for 154 lbs pt, loss of 750-1300 ml / blood) this is 3 units of loss

2. external fluid loss – trauma, surgery, vomiting, diarrhea, diuresis, diabetes insipidus

3. internal fluid loss – hemorrhage, burns, ascites, peritonitis, dehydration, third space

4. progression: treatment is *prevention, correct underlying cause. ie with nausea give antiemetics

monitor blood glucose

Hypovolemic Shock leads to:

1. decreased blood volume which leads to↓

2. decreased venous return which leads to ↓

3. decreased stroke volume which leads to ↓

4. decreased cardiac output which leads to ↓

5. decreased kidney perfusion

*try to give packed red cells, give lactated ringers sol'n and .9 normal saline, elevate feet to↑BP

(this is called "shock position" or modified trendelenberg)