Great video with fantastic examples and very clear explanations. The manner and speed in which you speak also makes it very easy to understand, not too slow or too fast. Also 10/10 for the gifs and memes which appealed to the millennial in me.
Awesome video. It's tricky to wrap your head around this physiology at times since there are many different clinical scenarios where this concept plays out. let's say we have an undifferentiated patient with sinus tachycardia who is normotensive with let's say a map of 80. Do you suggest then to simply dissect the differential thinking into either volume depletion or vasodilation (of unknown cause)? And depending on the answer, we pick either volume to counteract hypovolemia or vasopressors to counteract vasodilation? The tricky thing is that a crashing patient needs resus immediately which is why volume will most likely always come first since it's readily available. The question is really at what point the transition to pressors is indicated and how to monitor both volume status and sympathetic tone in a timely fashion (vexus exam, art line, central line etc) - it's difficult to gauge this in a non-icu setting
Thanks Andre. You are right. We always need to apply pre-test probability and initiate appropriate treatment. Tachycardia of course has many causes so may have nothing to do with volume or compliance!
Thanks for the video. This makes perfect sense and hits directly a question I've always had regarding sepsis treatment algorithms. Is there any reason (apart from being less afraid) to give fluids before vasopressors in sepsis? Not asking for the usual bad practice of fluid overloading prior to starting vasopressors, but for the order: why do most guidelines not recommend starting with vasopressors instead of (or at least at the same time that) fluids? Thanks a lot in advance.
Thanks for your question. If there has not been any fluid loss then yes it would be better to give vasopressors instead of fluids. The logistical difficulty is that then they need managing in a critical care area.
Excellent talk. Also, the video linked at the end is amazing. Thanks.
Glad it was helpful!
Great video with fantastic examples and very clear explanations. The manner and speed in which you speak also makes it very easy to understand, not too slow or too fast. Also 10/10 for the gifs and memes which appealed to the millennial in me.
Thanks so much Rachel. Appreciate the feedback
Excellent presentation!
Thanks!
Excellent! Thank you so much.
You're very welcome!
Well done Ashley!
Thanks Kumaresh - hope you're well!
Awesome video. It's tricky to wrap your head around this physiology at times since there are many different clinical scenarios where this concept plays out. let's say we have an undifferentiated patient with sinus tachycardia who is normotensive with let's say a map of 80. Do you suggest then to simply dissect the differential thinking into either volume depletion or vasodilation (of unknown cause)? And depending on the answer, we pick either volume to counteract hypovolemia or vasopressors to counteract vasodilation?
The tricky thing is that a crashing patient needs resus immediately which is why volume will most likely always come first since it's readily available. The question is really at what point the transition to pressors is indicated and how to monitor both volume status and sympathetic tone in a timely fashion (vexus exam, art line, central line etc) - it's difficult to gauge this in a non-icu setting
Thanks Andre. You are right. We always need to apply pre-test probability and initiate appropriate treatment. Tachycardia of course has many causes so may have nothing to do with volume or compliance!
Thanks for the video. This makes perfect sense and hits directly a question I've always had regarding sepsis treatment algorithms. Is there any reason (apart from being less afraid) to give fluids before vasopressors in sepsis? Not asking for the usual bad practice of fluid overloading prior to starting vasopressors, but for the order: why do most guidelines not recommend starting with vasopressors instead of (or at least at the same time that) fluids? Thanks a lot in advance.
Thanks for your question. If there has not been any fluid loss then yes it would be better to give vasopressors instead of fluids. The logistical difficulty is that then they need managing in a critical care area.
🤯👌🏼
Hemodynamic assessment lecture ???