Typical Board Question

[proman]

Since this is a dying board, here's a question I saw on one of our whiteboards (without the answer).

Baseline After medication
BP 80/58 84/64
CVP 22 23
RV 42/23 42/23
PA 48/28 50/28
PAOP 28 28
CI 1.6 2.5
HR 120 128

What was given?
A Amrinone
B Norepinephrine
C Nitroprusside
D Nitroglycerin
E Dopamine

Discuss.

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[DreamMachine]

Since this is a dying board, here's a question I saw on one of our whiteboards (without the answer).

Baseline After medication
BP 80/58 84/64
CVP 22 23
RV 42/23 42/23
PA 48/28 50/28
PAOP 28 28
CI 1.6 2.5
HR 120 128

What was given?
A Amrinone
B Norepinephrine
C Nitroprusside
D Nitroglycerin
E Dopamine

Discuss.

C and D are easy to rule out since BPs are increasing.

Amrinone would decrease PA pressures.

Norepi vs Dopamine...

I think the effects seen here are mostly beta and a little alpha.

Norepi is mostly alpha and less beta.

Dopamine is mostly beta and less alpha.

I would go with Dopamine...I guess.

 

[paiute]

I think the CI increased much more than expected for a dopamine effect, considering the relatively small increase in BP and HR. My guess is amrinone.

 

[pgg]

I'd go with amrinone too, +inotrope & vasodilator --> SVR probably dropped a bit but the increased CI kept systemic BP about the same.

 

[QuakerGasPasser]

I don't get it. You give amrinone, alone, BP will drop, period. No? Can output really go up so much as to overcompensate? Am I an idiot?

 

[Lonestar]

i am thinking Dopamine primarily b/c the pulm pressures haven't dropped.

 

[paiute]

somebody please give us the answer!

 

[proman]

I don't know the "correct" answer, but I'm convinced it's dopamine.

Dream Machine has the rationale that I (and the attendings I've asked) agree with. NE would increase the BP whereas DA would have only a mild effect on BP because the the difference in alpha affinity.

 

[dhb]

I would go with dopamine too.

 

[gasmann]

i concur - dopamine makes much more sense
NE - would incr BP and also likely cause reflex bradycardia - here we see an incr in HR
amrinone - is an inodilator and works more on RT side of heart - so should see a decr in CVP and also decr in RV.

CI elevation may be secondary to mainly the increase in HR as well..

 

[sweetalkr]

dopamine.

amrinone and the PDE inhibitors are used to decrease PVR in pulm htnsives and rv failure.
NE would raise BP much higher

dopamine could cause this, although remember 0-3 is dopamine, 3-10 is also beta, greater than 10 is more alpha with pure alpha over 20