Pulse Dosing For Hypotension

In this video we demonstrate how to use pulse doses of diluted epinephrine to support the blood pressure of a hypotensive patient. The patient was intoxicated with alcohol and had taken a handful of medications which included dicyclomine, melatonin, lisinopril and trazodone. He was hypotensive on arrival in the emergency department and his first recorded blood pressure was 59 systolic. His blood pressure remained low despite several liters of fluid. Rather than place an arterial, a central line and start the continuous infusion of a pressor, we decided to give the patient pulse doses of epinephrine diluted to 10 micrograms/mL. The patient's condition responded very nicely to the combination of fluids and small intermittent doses of diluted epinephrine. Phenylephrine can also be used for this purpose.