Over the last several years, I have seen a significant increase in the use of push-dose pressors in the ED. If you are not already doing so, hopefully, you can put these tips and tricks into action on your next shift!
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ACEP Now: June 2025 (Digital)
Dr. Jansson is an assistant professor of emergency medicine at Harvard Medical School and an emergency and critical care physician at Brigham and Women’s Hospital in Boston. He practices in both the ED and ICU.
References
- Holden D, Ramich J, Timm E, et al. Safety considerations and guideline-based safe use recommendations for “bolus-dose” vasopressors in the emergency department. Ann Emerg Med. 2018;71(1):83-92.
- Tisdale JE, Patel R V, Webb CR, et al. Proarrhythmic effects of intravenous vasopressors. Vol. 29, Ann Pharmacother. 1995.
- Nawrocki PS, Poremba M, Lawner BJ. Push dose epinephrine use in the management of hypotension during critical care transport. Prehospital Emergency Care. 2020;24(2):188-195.
- Berkenbush M, Singh L, Sessa K, Saadi R. Scoping review: is push-dose norepinephrine a better choice? West J Emerg Med. 2024;25(5):708-714.
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- Weingart S. Push Dose Pressors. https://emcrit.org/wp-content/uploads/push-dose-pressors.pdf. Accessed March 5, 2025.
- Browning B. Push-Dose Pressors. https://www.emdocs.net/push-dose-pressors/. Published: January 4, 2014. Accessed June 3, 2025.
- Tilton LJ, Eginger KH. Utility of push-dose vasopressors for temporary treatment of hypotension in the emergency department. J Emerg Nurs. 2016;42(3):279-281.
- Tian DH, Smyth C, Keijzers G, et al. Safety of peripheral administration of vasopressor medications: a systematic review. Emerg Med Australas. 2020;32(2):220-227.
- Lewis T, Merchan C, Altshuler D, Papadopoulos J. Safety of the peripheral administration of vasopressor agents. J Intensive Care Med. 2019;34(1):26-33.
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One Response to “Push-Dose Pressors in the Emergency Department”
July 7, 2025
Seattle ER docGreat column. I’d love to see a follow up: what is the evidence that push dose pressors make a difference in patient outcomes?
We could just be treating numbers on a monitor, or maybe it’s actually helping the patient. Is there value in certain situations (e.g. EMS transport, bridging to pressor infusion in septic shock) but not in other situations (e.g. transient hypotension after intubation or procedural sedation)? A deep dive into the topic would be great.