Vasopressors

Common Errors

Critical errors in prehospital application of vasopressors:

• Failing to reassess after intervention. Vital signs must be rechecked every 5 minutes for unstable patients
• Incorrect medication dosing. Always use length-based estimation (Broselow tape) for pediatric patients
• Tunnel vision on one finding while missing the complete clinical picture
• Not communicating changes to receiving facility during transport

Overview

Medications increasing blood pressure: norepinephrine, dopamine, phenylephrine, and vasopressin for refractory hypotension. Vasopressor indications and dosing tested on Paramedic exam.

In prehospital assessment, blood pressure reference range: adult 90/60-120/80 mmHg, pediatric 70+(2*age) systolic minimum. Deviations from these norms guide treatment decisions in the field.

Patient Communication

Communication about vasopressors in the prehospital setting includes: explaining procedures to the patient in simple terms, obtaining informed consent when possible (implied consent for unresponsive patients), providing a calm and reassuring presence, and delivering a structured handoff report (SBAR: Situation, Background, Assessment, Recommendation) to the receiving facility.

Historical Context

The modern EMS system in the United States traces to the 1966 "Accidental Death and Disability" white paper (NAS/NRC). Understanding of vasopressors has advanced significantly with evidence-based protocols. The NREMT, founded in 1970, standardized certification levels. Current ACLS and PALS guidelines are updated every 5 years by the AHA based on the International Liaison Committee on Resuscitation (ILCOR) evidence review.

Practical Example