Guest guest Posted February 13, 2007 Report Share Posted February 13, 2007 Ok. I have a question about Norepi. It's indicated for cardiogenic shock, but it increases cardiac contractility and therefore the cardiac workload. It takes the blood from the peripheral and rushes it into the trunk, making BP go up. Wouldn't this increased workload make the condition worse? Shock is not the underlying cause of 'oopses'.. it's the result of something greater. So.. if you rush a bunch of blood into the trunk wouldn't the underlying 'oops' become more apparent and more unstable? I ask this as a paramedic student. I've received many answers, but none that truly 'click' and make everything all better. - Finch, EMT-B Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 14, 2007 Report Share Posted February 14, 2007 Actualy Norepi/Levophed has more affects on peripheral vasoconstriction than contractility. It will cause an increase in afterload and increase the workload of the heart from the increase in afterload, but the idea behind using it is to increase the patient's coronary perfusion pressure by you using this drug in combination with an inotrope (Dobutamine, Dopamine). What you are doing is bringing blood from the peripheral to the trunk with the Levophed (increasing blood supply to the heart) then you would use the inotrope to increase the the actual cardiac output (with and increase in stroke volume and heart rate). You have to make sure that the heart has the blood supply before you add the inotropes. As indicated by blood pressure. You would only do this after proper fluid resuscitation. You only do this after proper fluid resuscitation. Once you have adequate perfusion you would then wean off the Levophed. Levophed is also a great drug in cases of septic shock. M. Shane R.N., CEN, EMT-P Flight Nurse/ Clinical Educator wrote: Ok. I have a question about Norepi. It's indicated for cardiogenic shock, but it increases cardiac contractility and therefore the cardiac workload. It takes the blood from the peripheral and rushes it into the trunk, making BP go up. Wouldn't this increased workload make the condition worse? Shock is not the underlying cause of 'oopses'.. it's the result of something greater. So.. if you rush a bunch of blood into the trunk wouldn't the underlying 'oops' become more apparent and more unstable? I ask this as a paramedic student. I've received many answers, but none that truly 'click' and make everything all better. - Finch, EMT-B --------------------------------- Finding fabulous fares is fun. Let Yahoo! FareChase search your favorite travel sites to find flight and hotel bargains. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 14, 2007 Report Share Posted February 14, 2007 Balancing cardiac output versus SVR in cardiogenic shock can be tricky. You'll find some that approach the problem with inotropes only, and others will use a potent inotrope with a vasodilator to help increase cardiac output while simultaneously reducing SVR and hopefully increasing BP and perfusion without a net increase in workload. While norepinephrine has some inotropic effect, it is primarily a potent vasoconstrictor. IOW, not the sort of agent you want to use in cardiogenic shock. -- Grayson, CCEMT-P, etc. MEDIC Training Solutions http://www.medictrainingsolutions.com/ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 14, 2007 Report Share Posted February 14, 2007 Also- considerations in spinal shock.... >>> shane smith 2/14/2007 9:30 am >>> Actualy Norepi/Levophed has more affects on peripheral vasoconstriction than contractility. It will cause an increase in afterload and increase the workload of the heart from the increase in afterload, but the idea behind using it is to increase the patient's coronary perfusion pressure by you using this drug in combination with an inotrope (Dobutamine, Dopamine). What you are doing is bringing blood from the peripheral to the trunk with the Levophed (increasing blood supply to the heart) then you would use the inotrope to increase the the actual cardiac output (with and increase in stroke volume and heart rate). You have to make sure that the heart has the blood supply before you add the inotropes. As indicated by blood pressure. You would only do this after proper fluid resuscitation. You only do this after proper fluid resuscitation. Once you have adequate perfusion you would then wean off the Levophed. Levophed is also a great drug in cases of septic shock. M. Shane R.N., CEN, EMT-P Flight Nurse/ Clinical Educator wrote: Ok. I have a question about Norepi. It's indicated for cardiogenic shock, but it increases cardiac contractility and therefore the cardiac workload. It takes the blood from the peripheral and rushes it into the trunk, making BP go up. Wouldn't this increased workload make the condition worse? Shock is not the underlying cause of 'oopses'.. it's the result of something greater. So.. if you rush a bunch of blood into the trunk wouldn't the underlying 'oops' become more apparent and more unstable? I ask this as a paramedic student. I've received many answers, but none that truly 'click' and make everything all better. - Finch, EMT-B --------------------------------- Finding fabulous fares is fun. Let Yahoo! FareChase search your favorite travel sites to find flight and hotel bargains. Quote Link to comment Share on other sites More sharing options...
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