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 staed , ventricular tachycardia develops and this is unresponsive to lidocaine. The V-tach conves back to sinus rhythm once the dopamine is stopped. At this point, which of the following treatments are most appropriate for this hypotensive patient?
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. Intraaoic balloon pump is invasive, therefore, less appropriate as a choice.
Amrinone
Dobutamine
Epinephrine
Phenylephrine
Shock