Cardiovascular Critical Care I

The patient returns to the ICU with a pulmonary

artery catheter in place and is currently receiving

dopamine at 12 mcg/kg/minute and norepinephrine

at 0.08 mcg/kg/minute with heart rate 108 beats/

minute, blood pressure 82/51 mm Hg, cardiac

index 2.0, central venous pressure (CVP) 26 mm

Hg, and pulmonary artery pressure 49/21 mm Hg.

The physician is concerned about right ventricular

dysfunction in the setting of shock and approaches

you for a recommendation to increase blood pres-

sure (BP). Ideally, the physician would prefer to

wean dopamine and minimize further increases in

pulmonary vascular resistance (PVR) because of the

presence of pulmonary hypertension. Which strat-

egy would be best to recommend?

wean the dopamine off if MAP is greater than

65 mm Hg.

wean the dopamine off if MAP is greater than

65 mm Hg.

wean the dopamine off if MAP is greater than

65 mm Hg.

Hours later, this patient goes into atrial fibrillation

(AF) with a heart rate of 126 beats/minute; how-

ever, the patient’s blood pressure remains 86/56 mm

Hg according to the regimen selected in the previ-

ous question. Which agent would you most likely

administer to manage the patient’s AF?

lowed by a continuous infusion at 1 mg/minute.

10 minutes, followed by a continuous infusion

at 1 mg/minute.

followed by 5 mg intravenous push every

6 hours.

a continuous infusion at 5 mg/hour and titrated

to maintain a heart rate of less than 110 beats/

minute.

Which medication-related quality metric would not

require documentation of contraindications based

on this patient’s clinical presentation (acute MI with

preserved LVEF)?

inhibitor/angiotensin receptor blocker (ARB)

contraindication.