Omayra Marrero, MD
- An elevated lactate, regardless of a normal blood pressure, is an indicator of poor prognosis and possible occult hypoperfusion. Resuscitate appropriately. Consider that it is due to both anaerobic causes and among other things, adrenergic stimulation.
- If considering right ventricular infarction, obtain a right sided EKG. Or keep it simple and move lead V4. A 1-mm elevation in lead V4R has a 71% sensitivity and 100% specificity for right ventricle infarction.
- In choosing a vasopressor, consider side effects as well as what receptor you are targeting. Higher levels of dopamine can lead to tachyarrhythmias; consider combining vasopressors to achieve better hemodynamic control while minimizing side effects.