March 24, 2025 admin No Comments

Summary

In this episode of the Overrun Podcast, Ed and Dan welcome intensivist Eddie Joe Gutierrez to discuss the use of vasopressors in emergency medical services (EMS). The conversation covers the challenges of peripheral IV access, the importance of early vasopressor administration in hypotensive patients, and the evolving understanding of fluid resuscitation in sepsis. Eddie emphasizes the significance of norepinephrine as a first-line vasopressor and compares it to phenylephrine, while also addressing the complexities of managing cardiogenic shock in the pre-hospital setting. In this conversation, Eddy Joe Gutierrez discusses critical aspects of managing shock and trauma in pre-hospital settings. He emphasizes the importance of understanding different types of shock, the role of vasopressors, and the challenges pre-hospital teams face. The discussion also covers the use of whole blood in trauma care and the growing interest in point-of-care ultrasound. Ultimately, the key takeaway is the urgency of restoring perfusion to patients as quickly as possible, with norepinephrine being the preferred vasopressor in many situations.

Takeaways

• Peripheral vasopressors are essential in pre-hospital settings.
• Doing nothing in critical situations is not an option.
• Fluid resuscitation has its limits; vasopressors may be necessary.
• Norepinephrine is preferred due to its dual action on alpha and beta receptors.
• Early administration of vasopressors can lead to better outcomes.
• The traditional approach of flooding patients with fluids is being reconsidered.
• Understanding hemodynamics is crucial for effective treatment.
• Phenylephrine may not be suitable for all patients due to its effects on cardiac output.
• Patient history is often limited in pre-hospital care, complicating treatment decisions.
• The focus should be on stabilizing the patient, regardless of the specific vasopressor used. Understanding the nuances of shock is crucial for effective management.
• Norepinephrine is often the first choice for vasopressor therapy.
• Whole blood administration can be beneficial in trauma cases.
• Point-of-care ultrasound is gaining traction but requires training.
• Pre-hospital teams face unique challenges without advanced tools.
• Restoring perfusion is the primary goal in critical care.
• The choice of vasopressor should be based on the patient’s condition.
• Effective communication between pre-hospital and hospital teams is essential.
• Training in ultrasound and other skills is evolving in medical education.
• The focus should always be on patient outcomes and safety.

Chapters

00:00 Introduction to Vasopressors in EMS
02:49 Peripheral IV Access and Vasopressors
05:54 Early Use of Vasopressors in Hypotensive Patients
09:04 Fluid Resuscitation vs. Vasopressors in Sepsis
12:00 Understanding Norepinephrine and Its Mechanism
14:58 Comparing Vasopressors: Norepinephrine vs. Phenylephrine
17:57 Cardiogenic Shock and Its Management
20:21 Understanding Shock: A Clinical Perspective
24:07 Trauma Management and Whole Blood Administration
26:56 Point-of-Care Ultrasound in Pre-Hospital Settings
29:13 Vasopressors: Choosing the Right Agent
36:52 Restoring Perfusion: The Key Takeaway

Eddy Joe’s work can be found on Instagram @eddyjoemd

Buy his book here

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