Treatment of hypotension in Sepsis

Question#: 654

Question:

Prehospital vasopressor (dopamine or epinephrine) for suspected suspected septic shock (infection with hypotension) following 20 mL/kg fluid bolus. This is a situation we may encounter in rural settings with long transport times. We are limited with our assessment tools: cultures, lactate, etc..; however, if the working dx appears to be sepsis is this treatment option encouraged/supported by initiating consult w BHP?

Answer:

With vasopressor therapy, control of the infusion is of the utmost importance for patient safety. The lack of pumps in the prehospital setting limits the options for blood pressure support to fluid therapy and dopamine. Epi/nor-epi carry significant risk due to low frequency of use and human factor issues, both calculating and monitoring administration. These mediations have a narrow margin for error, particularly in the back of a moving vehicle. Dopamine is premixed and the safest next step after a normal saline bolus has "primed the pump"