Rewarming Shock


When a profoundly hypothermic patient is externally rewarmed, vasodilation in the skin occurs. With the distribution of a large portion of plasma volume to the skin there may be ensuing hypotension. In addition to causing vasodilation, external rewarming may result in further cooling of the core ("afterdrop"), which may worsen the patient's cardiac output.

TREATMENT

  Receptor Activity    
Agent a1 b1 b2 DA  
Effects
Indication
Phenylephrine
40-180 mcg/min
+++ 0 0 0 SVR ↑↑
CO ↔/↑
Sepsis,
Neurogenic shock
(Levophed)
Norepinephrine
1-30 mcg/min
+++ ++ 0 0 SVR ↑↑
CO ↔↓↑
Sepsis
Epinephrine +++ +++ ++ 0 CO ↑↑
SVR ↓ (L)
SVR ↔/↑ (H)
Anaphylaxis,
ACLS,
Sepsis
Dopamine (mcg/kg/min)
Low-dose (0.5-2) 0 + 0 ++ CO ↑
SVR ↑↓
Sepsis,
Cardiogenic shock
Mid-dose(5-10) + ++ 0 ++ CO ↑
High-dose(10-20) ++ ++ 0 ++ SVR ↑↑
Doubutamine
2.5-20 mcg/kg/min
0/+ +++ ++ 0 CO ↑
SVR ↓
Cardiogenic shock
Isoproterenol
2-10 mcg/min
0 +++ +++ 0 CO ↑
SVR ↓
Cardiogenic shock w/
bradycardia
Vasopressin
(Adjunct)
0.01-0.04 U/min
        V2 receptors Vasoconstriction
Augments catecholamine