Vasoplegia

Vasoplegia, characterized by profound hypotension and a hyperdynamic, underfilled left ventricle, is the central focus. It's crucial to exclude other conditions like RV failure or valvular issues before diagnosing vasoplegia, which presents as a large "swimming pool" of volume that the body can't effectively utilize. To repressurize the system, diversifying vasopressor mechanisms is key, with early vasopressin or angiotensin considered, especially in patients on ACE inhibitors or ARBs. Steroids are also important, particularly for those with adrenal insufficiency from chronic steroid or opioid use, or a history of TBI. Correcting acidemia via increased minute ventilation and judicious use of bicarbonate, along with addressing hypocalcemia with calcium supplementation, are also critical steps. In cases of inappropriate bradycardia, epinephrine or dopamine may be needed, and rescue therapies like methylene blue or cyanokit can be employed when other methods fail.