Vasoactive medications are one of the pillars of management of shock in Emergency Departments. Inopressors, namely Norepinephrine and Epinephrine, are the two most commonly used pressors in US Emergency Departments, used most frequently to treat distributive shock.

More recently, “push dose pressors” have become increasingly recognized as a means to achieve rapid hemodynamic improvement in unstable patients, and pre-emptively during intubation in patients at risk of peri-intubation arrest.

Unlike distributive shock, the current cornerstones of the management of hemorrhagic shock are timely hemorrhage control with simultaneous balanced volume resuscitation.

Traditionally, vasoactive agents have been contraindicated in early hemorrhagic shock, secondary to their deleterious consequences and increased mortality risk.

ATLS does not recommend the use of vasopressors.

Given the retrospective nature of these studies, the use of vasopressors may represent a marker of increased severity of illness rather than a direct contributor to adverse outcomes.

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