Paramedic National Registry Practice

What is the appropriate treatment for a hypotensive CHF patient?

1. Dopamine Drip @ 5-15 mcg/kg/min

2. Fluid Resuscitation

3. Nitroglycerin

4. ACE Inhibitors

The correct answer is: Dopamine Drip @ 5-15 mcg/kg/min

In the context of treating a hypotensive patient with congestive heart failure (CHF), using a dopamine drip at a dose of 5-15 mcg/kg/min can be appropriate due to its inotropic and vasopressor effects. Dopamine can help improve cardiac output by increasing the heart's contractility, which is crucial when dealing with CHF, where the heart may struggle to pump effectively. At this dosage, dopamine can also lead to peripheral vasodilation, which may assist in correcting hypotension while simultaneously supporting adequate renal perfusion, provided the dosage is carefully monitored. While fluid resuscitation might seem like a possible choice, it can be counterproductive in CHF patients who are often already volume overloaded; administering fluids can exacerbate pulmonary congestion. Nitroglycerin, while useful in relieving chest pain and reducing preload, may not be suitable for hypotensive patients as it could further lower blood pressure. ACE inhibitors are typically utilized in managing CHF and hypertension, but they aren’t the immediate treatment of choice for an acute hypotensive episode. Thus, the selected treatment through dopamine administration not only aims to stabilize blood pressure but also addresses the underlying hemodynamic issues that arise from CHF.