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2 Minute EBP Challenge

Monday, January 30, 2012
Scrub the Hub
The Centers for Disease Control (CDC) recommends that central venous catheter (CVC) hubs be scrubbed for how long?

Monday, January 23, 2012
Severe Sepsis and AF Risk
Up to 20% of patients with severe sepsis develop a new onset atrial fibrillation.  Which factor was not associated with increased risk?

Monday, January 16, 2012
Unreported Hospital Errors
In a recent study the Department of Health and Human Service reports that what percentage of hospital errors go unreported?

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  • Get tips, timesavers, and more from
    David W. Woodruff, MSN, RN-BC, CNS, CMSRN, CEN

    Home > 2 Minute EBP Challenge > What vasopressor is best for Cardiogenic Shock?

    What vasopressor is best for Cardiogenic Shock?

    Monday, April 05, 2010
     

    Stay up-to-date the easy way!

    How would you answer this question? 

    Mr. Thomas was admitted with an acute myocardial infarction.  Over the previous hour he has become tachycardic and hypotensive.  In the treatment of cardiogenic shock, which vasopressor was shown to increase 28-day survival? 

    a. Dopamine
    b. Neosynephrine
    c. Epinephrine
    d. Norepinephrine

    The correct answer is "d" norepinephrine.
    Dopamine and norepinephrine are commonly used medications that cause both positive inotropic (contraction) effects and positive chronotropic (rate) effects.  They work by stimulating the same receptors that the body's own sympathetic nervous system stimulates, but each drug works a little differently in how it causes the blood pressure to rise.

    DeBacker and associates studied how well patients responded to dopamine and norepinephrine and their respective 28-day survival rates.  They found that for shock in general there was no difference in 28-day mortality.  Dopamine did cause more arrhythmias, though.

    In patients with cardiogenic shock, however, the death rate was significantly higher in patients treated with dopamine than in patients treated with norepinephine.  The authors recommended a change to the American Heart Association guidelines that recommend dopamine in cardiogenic shock.

    Both epinephrine and neosynephrine will increase blood pressure in shock, but also increase cardiac workload and are not recommended for cardiogenic shock.

    From:  De Backer, D., et al. (2010). Comparison of dopamine and norepinephrine in the treatment of shock. New England Journal of Medicine: 362; 779.

    Levy, J.H. (2010). Treating shock -- Old drugs, new ideas. New England Journal of Medicine: 362; 841.

    Best wishes,
    David W. Woodruff, MSN, RN-BC, CNS, CEN
    President,     Ed4Nurses, Inc.

    PS. PJs, bunny slippers, and professional education? Call about our web-based seminars that you can attend from home!  (800) 990-2629.

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