During the treatment of septic shock, a 28-year- old male remains hypotensive despite adequate volume replacement; PA occlusion pressure is 18 mm Hg. When dopamine is started, ventricular tachycardia develops and this is unresponsive to lidocaine. The V-tach converts back to sinus rhythm once the dopamine is stopped. At this point, which of the following treatments are most appropriate for this hypotensive patient?
Amrinone
Dobutamine
Epinephrine
Phenylephrine
Dopamine activates b1 -receptors and this was probably the reason for the arrhythmia. Amrinone will inhibit phosphodiesterase and result in an increased cyclic AMP level, producing the same result as b-receptor stimulation. Dobutamine and epinephrine also stimulate the b- receptors. The only choice which stimulates only a-adrenergic receptors is phenylephrine. Intra-aortic balloon pump is invasive, therefore, less appropriate as a choice.
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