Vasopressors in Trauma?

I was always taught that you NEVER use vasopressors in trauma patients with hemorrhagic shock as it could worsen bleeding and increase tissue ischemia. This dogma has been challenged over the past few years and we now also have an RCT that argues against not using vasopressors in trauma patients with hemorrhagic shock. Regardless of where you fall in this debate, it seems times are changing.
Join this channel to get access to perks:
/ @salimrezaie

[@rattler815]

Excellent review. Would love to hear more at the Conference level. Thanks for all your work!

[@SalimRezaie]

TY so much.

[@thegeorge5879]

I really like your work, thank you !

[@SalimRezaie]

Many thanks!

[@Nomanali-lk8mz]

Excellent review. Thanx

[@SalimRezaie]

Thanks for watching!

[@gsresener]

it's a very important question here in Brazil, the majority of EDs don't have any blood products, so, how do you keep your patient alive untill he reaches the surgical center at another hospital? I take we know that 2L of cristalloids is worse than 1L and we don't know if any cristalloid is good, but thinking about a minimum preload, thinking about Frank-Starling and so... we titerate cristalloids and then what is less harmful? starting pressors of giving more cristalloids? i think it's a though call and we should study more, as we won't have blood everywhere in any near future

[@SalimRezaie]

Agreed...I think vasopressor over crystalloid IMHO...I also work at some centers where blood not available...vasopressors a bridge to buy time until transfer to appropriate facility...we have enough evidence that too much crystalloid is harmful in these patients

[@robertolarios7561]

Anesthesia & Analgesia 135(6):p 1245-1252, December 2022. | DOI: 10.1213/ANE.0000000000005949, release an article stating: phenylephrine should be used first before norepinephrine if the cause of hypotension is severe TBI.

[@SalimRezaie]

Great find...as stated in the video...suspect use of vasopressors in trauma is nuanced and there is no one size fits all