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Cold Shock: Low BP(1)

WARM SHOCK COLD SHOCK – LOW BP COLD SHOCK – NORMAL BP
Titrate NOREPINEPHRINE starting dose: 0.05 mcg/kg/min  Second line:Add epinephrine, or vasopressin Titrate EPINEPHRINE starting dose: 0.05 mcg/kg/min  Second line:Add norepinephrine, or dobutamine If in shock (i.e., ScvO2 < 70%), titrate EPINEPHRINE starting dose: 0.03 mcg/kg/min Consider:Dobutamine starting dose: 5mcg/kg/min or Milrinone starting dose: 0.3mcg/kg/min, no loading dose (Caution: Milrinone may cause hypotension)

    

Arterial line, CVL, Foley should be placed for patients on vasoactive infusion for > 1 hour, if not already in place.

 

Retrieved from: http://www.chop.edu/clinical-pathway/icu-clinical-pathway-infants-28-days-and-children-severe-sepsisseptic-shock

WARM SHOCK

COLD SHOCK – LOW BP

COLD SHOCK – NORMAL BP

Titrate NOREPINEPHRINE starting dose: 0.05 mcg/kg/min

 

 

Second line:

Add epinephrine, or vasopressin

Titrate EPINEPHRINE starting dose: 0.05 mcg/kg/min

 

 

Second line:

Add norepinephrine, or dobutamine

If in shock (i.e., ScvO2 < 70%), titrate EPINEPHRINE starting dose: 0.03 mcg/kg/min

 

Consider:

Dobutamine starting dose: 5mcg/kg/min or Milrinone starting dose: 0.3mcg/kg/min, no loading dose (Caution: Milrinone may cause hypotension)

    

Arterial line, CVL, Foley should be placed for patients on vasoactive infusion for > 1 hour, if not already in place.

 

Retrieved from: http://www.chop.edu/clinical-pathway/icu-clinical-pathway-infants-28-days-and-children-severe-sepsisseptic-shock

These guidelines do not establish a standard of care to be followed in every case. It is recognized that each case is different and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare guidelines for each. Accordingly these guidelines should guide care with the understanding that departures from them may be required at times.