This is EMKases, EM Quick Hits podcast, where our team of experts and educators bringing clear, concise, and condensed, practice-changing knowledge on all those EM topics you may not be totally comfortable with.

Cases, the latest evidence, procedural tips and tricks, pitfalls to avoid, and the key take-home points and references on the EMCases website.

Quick, let's get on with it.

EMCases is part of Shremi, the Schwartz-Risman Emergency Medicine Institute.

That's the nonprofit organization dedicated to improving EM care through

high quality research and education. The opinions expressed on this podcast are intended for general

information and educational purposes only and should not be used to diagnose treat or prevent any

medical condition, nor should they be used as a substitute for medical advice from qualified

practicing physician. Unless stated otherwise, the opinions expressed by the hosts or guests are made in their

individual capacity, not on behalf of the Institute nor medicine cases.

You know when you've got a patient who's in shock and you've done all the right things,

you've got your team working away at monitors and lines and volume resuscitation,

you might be preparing for intubation, you've started a vasopressor,

you expect that what you're doing will work, especially the vasopressor.

What happens when your vasopressor does not work as expected? What next?

Let's listen to Swami based on some educational goal done by Ruben Strayer,

Critical Care Now and Salim Rosey, and see what he has to say about what diagnoses to consider and address after your first vasopressor has failed. In the emergency department, we see lots of different types of

shock, hemorrhagic, anaphylactic, septic, there's so many different varieties. And we've

spent a lot of time talking about how to identify the different causes, how to treat the

different causes, and then we'd like to get them away from us, get them off to the ICU or wherever

their ultimate destination is.

But sometimes these patients stay with us longer.

...