Prolonged Field Care Podcast PFC Podcast: Vasopressors and Shock Management
Mar 12, 2026
A deep dive into choosing and monitoring vasopressors for shock. They compare epinephrine and norepinephrine, explain major side effects and lactic acid concerns. Practical guidance on fluid resuscitation in sepsis and anaphylaxis is highlighted. Tips cover push-dose epinephrine, when to start drips, MAP targets, managing tachycardia, and working with limited resources.
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Epinephrine Can Drive Lactic Acidosis Independent Of Perfusion
- Epinephrine infusions can raise lactate because it metabolizes into lactate, potentially causing lactic acidosis unrelated to tissue hypoperfusion.
- Doug notes the clinical harm depends on resulting pH, which is hard to measure in austere settings.
Give Fluids Before Pressors In Distributive Shock
- Always give fluids first in sepsis and anaphylaxis; intravascular volume replacement is the foundation of resuscitation.
- Doug explains distributive shock dilates the vascular space, so pressors without volume risk poor preload and cardiac failure.
Use Fluids And IM Epi Before Starting An Epi Infusion
- In anaphylaxis, prioritize fluids and intramuscular epinephrine; start an epinephrine infusion only if hypotension persists despite repeated IM doses and volume resuscitation.
- Doug cites guidelines recommending this sequence to avoid unnecessary drips.