Carolinas Core Concepts Core Concepts in EM; a repository for Carolinas lecture summaries.


Critical Care Myths: Hemodynamics

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.
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