Nguyên nhân hạ huyết áp IVC phẳng phẳng bình thường hoặc giãn Dilated bình thường hoặc tăng thường hoặc cỡ nhỏ lớn lớn Giảm khu vực hoặc trên toàn cầu bình thường, bình thường hoặc lớn thường hoặc lớn bình thường hoặc giảm nhỏ Tăng nhỏ tăng LV kích thước LV kích thước RV co | TABLE Echocardiographic findings in hypotension Cause of hypotension IVC LV size LV contraction RV size RV contraction Hypovolemia Flat Small Increased Small Increased Sepsis Flat Normal or large Normal or reduced Normal or large Normal or reduced LV dysfunction due to ischemia Normal or dilated Large Reduced regionally or globally Normal Normal unless associated RV infa rction Acute major pulmonary embolism Dilated Normal or small Normal or increased La rge Reduced Cardiac tamponade Dilated Normal Normal or increased Normal Diastolic free wall collapse RV infarction Dilated Normal or large if associated LV inferior infarction Normal or reduced if associated inferior infa rction La rge Reduced IVC inferior vena cava LV left ventricular RV right ventricular. UOỊSU9ỊOdĂ - CHAPTER 9 57 58 COMMON PRESENTATIONS TABLE Inotropic vasopressor therapy Cause of hypotension clinical setting Left ventricular failure Right ventricular infarction . . i Pulmonary embolism Bradycardia and hypotension Cardiac tamponade while awaiting pericardiocentesis Septic shock after fluid resuscitation Anaphylactic shock Choice of therapy Systolic BP 90 mmHg dobutamine Systolic BP 80-90mmHg dopamine Systolic BP 80 mmHg norepinephrine Epinephrine Norepinephrine Norepinephrine as first-line agent Dobutamine should be added if cardiac output is low Epinephrine Drug Dosage pg kg min Dobutamine 5-40 Dopamine 5-10 10-40 Epinephrine Norepinephrine Effect Beta-1 inotropism and beta-2 vasodilatation Beta-1 inotropism Alfa-1 vasoconstriction Beta-1 inotropism and beta-2 vasodilatation Beta-1 inotropism and alfa-1 vasoconstriction Alfa-1 vasoconstriction and beta-1 inotropism 10 Sepsis and septic shock Continued 3 Q. .
