Consider Three Clinical scenarios:
Scenario A:
EMS responds to the scene of a cardiac arrest. Patient is found in PEA and ROSC is achieved after 5 cycles of CPR. Immediately Post-ROSC and 3 minutes since the last dose of epinephrine, blood pressure is 110/80, HR 125, EtCO2 45 mmHg, SpO2 of 95%. Post-ROSC EKG shows an inferior MI. As the patient is being packaged for transport, a repeat blood pressure of 70/30 is obtained, HR is now 90, and EtCO2 has declined to 30 mmHg. The paramedic considers starting an epinephrine or norepinephrine drip, but thinks that utilization of push dose pressors may suffice and make it easier to rapidly extricate patient and begin transport towards the local STEMI receiving center…
Scenario B:
EMS responds to an assisted living facility for altered mental status in a 78 year-old male. The patient has been becoming progressively more altered over the course of the day and the nursing home reports a fever. The patient is obtunded and responds only to painful stimuli. An indwelling Foley catheter is noted to be draining cloudy urine. VS obtained show a BP 68/30, HR 110, SpO2 89% on room air, RR 24, EtCO2 22 mmHg. IV access x 2 is obtained on scene, and fluids and oxygen administration are initiated. The paramedic considers whether push dose pressors may be indicated for this patient…
Scenario C:
EMS responds to a motor vehicle collision. The patient has suffered major blunt trauma to the head and pelvis. Assisted ventilations are initiated, the patient is placed in spinal motion restriction, and a pelvic binder is applied. Transport is initiated to the nearest trauma center which is 15 minutes away. VS are BP 80/60, HR 120, RR 12 (assisted), SpO2 96%, EtCO2 30 mmHg. IV access is initiated and the paramedic considers push dose pressors to support the blood pressure in anticipation of need for airway management en route or in the ED…