Vasopressors In Trauma Flashcards
(22 cards)
Inotrope
Affects force of muscular contraction
Positive inotropes -> pump harder
Types of ionotroped
Adrenoreceptor agonists
Drugs effecting intracellular calcium availability and effects
Drugs modifying SVR
Mechanisms of ionotropes
Increase extracellular calcium levels
Adrenoreceptor -> modulate cAMP and modify intracellular calcium levels
Phosphodiesterase inhibitors inhibit cAMP breakdown
Calcium sensitisation
Calcium chloride ionotropic mechanism
Increase extracellular ca level
Catecholamines ionotropic mechanism
Activate G protein linked adrenoreceptor causing modulation of camp modifying intracellular calcium levels
Milronone ionotropic mechanism
Phosphodiesterase inhibitor - inhibits cAMP breakdown
Levosimendan ionotropic mechanism
Calcium sensitisation
Effects of alpha 1 activation
Smooth muscle contraction
Mydriasis
vasoconstriction - skin, muscosa, abdominal viscera
Sphincter contraction - GI tract and bladder
Effects of alpha 2 activation
Smooth muscle mixed effects
Noradrenaline inhibition
Platelet activation
Effects of alpha 3 activation
Positive chronotropic and ionotropic effects
Effects of beta activation
Positive chronotropic and ionotropic effects
Smooth muscle relaxation
Lipolysis
Detrusor relaxation
Alpha 1/2 agonists
Noradrenaline > adrenaline
Phenylephrine
Beta 1/2 agonists
Adrenaline
Noradrenaline
Dobutamine
Isoprenaline
Ephedrine
Factors effecting circulation
Volume loss
Increased capacitance - neurogenic, inflammatory
Pump failure
Management of volume loss
Control ongoing losses
Replenish losses
How can spinal injury effect circulation
Vasodilation below level of injury
Disruption of sympathetic supply to heart
How can trauma lead to inflammation
Traumatically injured tuissue causes cytokine release
Sepsis due to infection
How do spinal injury and inflammation effect capacitance, and how should this be managed
Decrease capacitance by increasing SVR
Judicious inotrope use
(Consider chronotropes for bradycardia caused by neuro injury)
How to manage pump failure
Inability to fill - Remove cause of inability to fill - release tamponade, decompress tension
Inability to pump - Inotrope to increase contractility, VA ECMO
What should be considered when using inotropes to increase contractility
Will Increase cardiac workload and oxygen demand
Does adrenaline or noradrenaline have more effect on alpha receptors
Noradrenaline
(Nor mostly pure alpha, alpha mixed alpha and beta)
How do noradrenaline and adrenaline effect HR and BP
Adren - incr BP, incr HR
Norad - incr BP, compensatory HR decr
