Department of Emergency Medicine, David Grant United States Air Force Medical Center, Travis Air Force Base, California; Department of Emergency Medicine, University of California at Davis, Medical Center, Sacramento, California.
Department of Pharmacy Services, University of California at Davis, Medical Center, Sacramento, California.
J Emerg Med. 2020 Feb;58(2):313-316. doi: 10.1016/j.jemermed.2019.12.026. Epub 2020 Mar 12.
Peri-intubation cardiac arrest and hypotension in patients with septic shock occur often in the emergency department (ED) and ultimately lead to worse clinical outcomes. In recent years, the use of push-dose, or bolus-dose, vasopressors in the ED have become common practice for transient hypotension and bridging to continuous infusion vasopressors. Push-dose epinephrine and phenylephrine are the agents used most frequently in this scenario.
A 63-year-old woman who was apneic and pulseless presented to our ED. After 4 min of cardiopulmonary resuscitation, spontaneous circulation was achieved, and the patient was intubated for airway protection. She became hypotensive with a blood pressure of 55/36 mm Hg. After receiving a 1-L bolus of lactated Ringer solution, she remained hypotensive with blood pressure of 80/51 mm Hg and a pulse of 129 beats/min. One unit of intravenous vasopressin push bolus was administered. Within 1 min, her hemodynamics improved to a blood pressure of 141/102 mm Hg and pulse of 120 beats/min. Over the next 2 h, her mean arterial pressure slowly and progressively declined from 120 to 80. No further vasoactive medications were required for approximately 120 min until norepinephrine and vasopressin was initiated for septic shock. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case report discusses the use of push-dose vasopressin as an alternate vasoactive medication to improve hemodynamics in a patient with vasodilatory septic shock.
脓毒性休克患者在急诊科常发生插管期心搏骤停和低血压，最终导致更差的临床结局。近年来，在急诊科使用推注剂量或冲击剂量血管加压药来治疗短暂性低血压和过渡到持续输注血管加压药已成为常规做法。在这种情况下，最常使用的推注剂量肾上腺素和苯肾上腺素。
一名 63 岁女性因呼吸暂停和无脉就诊于我院急诊科。心肺复苏 4 分钟后，自主循环恢复，患者行气管插管以保护气道。她出现低血压，血压为 55/36mmHg。在接受 1L 乳酸林格氏液冲击后，她仍处于低血压状态，血压为 80/51mmHg，脉搏为 129 次/分。给予 1 单位静脉注射血管加压素推注。1 分钟内，她的血流动力学改善，血压为 141/102mmHg，脉搏为 120 次/分。在接下来的 2 小时内，她的平均动脉压从 120mmHg 缓慢而逐渐下降至 80mmHg。大约 120 分钟内，她不需要进一步的血管活性药物，直到开始治疗脓毒性休克时使用去甲肾上腺素和血管加压素。
急诊医师为何应该了解本病例？：本病例报告讨论了使用推注剂量血管加压素作为血管扩张性脓毒性休克患者改善血流动力学的替代血管活性药物。
