Manson Daniel K, Dzierba Amy L, Seitz Kaitlin M, Brodie Daniel
Division of Pulmonary, Allergy, and Critical Care Medicine and.
Department of Pharmacy, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York; and.
ATS Sch. 2023 Feb 13;4(2):216-229. doi: 10.34197/ats-scholar.2021-0132HT. eCollection 2023 Jun.
Vasopressors are widely used in the management of shock among critically ill patients. The physiology of vasopressors and adrenoreceptors and their effects on end organs therefore represent important, high-yield topics for learners in the critical care environment. In this report, we describe our approach to teaching this core concept using the stereotypical human physiologic response when running from a bear, in the context of the relevant supporting literature. We use escaping from a threatening predator as a lens to describe the end-organ effects of activating adrenoreceptors together with the effects of endogenous and exogenous catecholamines and vasopressors. After reviewing this foundational physiology, we transition to the clinical environment, reviewing the pathophysiology of various shock states. We then consolidate our teaching by integrating the physiology of adrenoreceptors with the pathophysiology of shock to understand the appropriateness of each therapy to various shock phenotypes. We emphasize to learners the importance of generating a hypothesis about a patient's physiology, testing that hypothesis with an intervention, and then revising the hypothesis as needed, a critical component in the management of critically ill patients.
血管升压药广泛应用于危重症患者休克的治疗。因此，血管升压药和肾上腺素能受体的生理学及其对终末器官的影响，是重症监护环境下学习者重要的高收益学习主题。在本报告中，我们结合相关支持文献，描述了我们利用从熊身边跑开时典型的人体生理反应来教授这一核心概念的方法。我们以逃离威胁性捕食者为视角，描述激活肾上腺素能受体对终末器官的影响，以及内源性和外源性儿茶酚胺与血管升压药的作用。在复习这一基础生理学知识后，我们转向临床环境，复习各种休克状态的病理生理学。然后，我们通过将肾上腺素能受体的生理学与休克的病理生理学相结合，巩固教学内容，以了解每种治疗方法对各种休克表型的适用性。我们向学习者强调，对患者的生理状况提出假设、通过干预来检验该假设，然后根据需要修改假设，这是危重症患者管理中的关键组成部分。
