TY - JOUR T1 - BET 2 JF - Emergency Medicine Journal JO - Emerg Med J SP - 556 LP - 558 DO - 10.1136/emj.2010.097329 VL - 27 IS - 7 A2 - , Y1 - 2010/07/01 UR - http://emj.bmj.com/content/27/7/556.abstract N2 - Report by: Amery Robinson, Emergency Medicine ResidentSearch checked by: Jeffrey Jones, Research Director, EM Residency ProgramInstitution: Grand Rapids Medical Education and Research Center, Grand Rapids, Michigan, USAThree-part questionFor [adult patients presenting to the emergency department or the intensive care unit] do [epinephrine, dopamine, dobutamine, or vasopressin] produce better [28 and 90 day mortality rates] than norepinephrine alone?Clinical scenarioA 74-year-old female presents from a nursing home with altered mental status and recent diagnosis of pneumonia. She is febrile, tachypnoeic, tachycardic, anuric, and has a blood pressure of 72/35. Your attending physician suggests you start her on an infusion of norepinephrine; however, epinephrine has more inotropic effect. You wonder what is the best vasopressor for your patient?Search strategyMedline 1950—3/10 using Ovid interface, Cochrane Library (2010), PubMed clinical queries[(exp shock, septic/drug therapy) AND (exp vasocontrictor agents or vasopressors.mp)] Limit to human and English.Search outcomeTrials were excluded if they were not designed to investigate mortality but rather surrogate measures such as blood pressure and cardiac index. A total of … ER -