Vasopressors and Inotropes

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Norepi is best first line for most types of shock. Pressors work best for distributive types (septic, osmotic/cirrhotics, but NOT anaphylaxis). Don’t mess around and delay starting pressors if suboptimal response to fluids. Early pressors work well, as they mobilize volume stored in central veins (which act as capacitors). Use weight-based dosing and titrate to central organ perfusion (mental status primarily, which needs MAP>50, but aim for 65), do not go in excess to cause AKI. Note that echo post-pressor may appear to have worse EF. This is due to increased workload; improved coronary perfusion pressure comes at a cost of increased demand.

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