Clinical Tips

Cap refill <1 second looks reassuring. It is not. In warm shock, extreme vasodilation causes flash refill — the blood

Four findings. Under one minute. Every reassessment. 1. Cap refill at STERNUM — firm 5s press, count return >2s = cold

Reality: 2 RCTs show epinephrine outperforms dopamine. Dopamine is no longer first-line Canadian Paediatric Society, 2

Warm flushed skin. Bounding pulses. Cap refill instant. BP 85/40. "Good perfusion" — right? Wrong. Pulse pressure: 45

Norepinephrine in cold shock: Increases afterload on an already failing heart → cardiac output drops further. You squee

HR 180. BP 70/50. Pale, mottled skin. Cap refill 4 seconds. Cool to mid-calf. Pulse pressure: 20 mmHg narrow. Weak thr

"COLD needs the HEAT" Cold shock → Epinephrine Beta-1 inotropy warms cardiac output + alpha-1 maintains vascular tone D

The U-shaped curve: aggressive lowering starves the brain. Uncontrolled elevation causes hemorrhage. For every 10mmHg

Before reperfusion: <185/110 or no tPA Post-reperfusion: tPA → 130-140 | EVT → 140-180 Spike = Stop and scan possible

Labetalol: 10-20mg IV push, repeat x1, then infusion 2-8 mg/min Nicardipine: Start 5 mg/h, ↑ 2.5 mg/h q5-15min, max 15

New SBP >180-230 or sudden change from baseline + headache, vomiting, or decreased consciousness? Immediate actions: 1

Reality: Post-EVT target is 140-180 mmHg Two RCTs ENCHANTED2/MT, OPTIMAL-BP stopped early because intensive control <