The Pump vs. The Squeeze: The Clinical Use of Vasopressors and Inotropes in the Back of a Helicopter

Managing hemodynamically unstable and crashing patients in the back of an ambulance or 10,000 feet in the air with the use of vasopressors and inotropes is very stressful and tricky. Although only a subset of our patients present with hemodynamic collapse and shock, a fundamental understanding of the use of inotropes and vasopressors is imperative to ensure good patient outcomes and reduce morbidity and mortality. This lecture will discuss the use of these pharmacological agents in differentiated (e.g., cardiogenic, distributive, hypovolemic, etc.) and undifferentiated/mixed shock states and ideal vasopressor/inotrope(s) to use as primary resuscitative agents. The most recent EMS literature surrounding these agents in different clinical scenarios will also be presented to ensure adequate understanding and comprehension.