| Shock persists despite escalation of two vasopressors |
- Discuss with N/IICU ECMO resource attending
- Consider initiation of additional vasopressor agents (e.g., dobutamine, epinephrine, norepinephrine, milrinone, vasopressin) or hydrocortisone if not already started
- Consider other etiology causing or contributing to refractory shock:
- Pneumothorax
- Pericardial effusion or cardiac tamponade
- Ventricular dysfunction
- Intravascular fluid status
- Electrolyte abnormalities (sodium, potassium, ionized calcium values)
- Consider obtaining CXR, ECHO, electrolytes and blood gas if not previously obtained
- Consider PICU or CICU consult
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