رجل عمره ٦٨ سنة في الصدمة القلبية بعد احتشاء، بدأ دوبيوتامين بالوريد. قبل الدواء كان النبض ١٠٤ والضغط ٨٢/٥٠. بعد ساعة صار الضغط ٩٦/٥٨، لكن النبض ١٣٨ مع ضربات بطينية مبكرة متكررة على الشاشة. ما الإجراء المناسب؟

A 68-year-old man in cardiogenic shock after an MI started IV dobutamine. Before it HR was 104 and BP 82/50. An hour later BP is 96/58 but HR is 138 with frequent premature ventricular beats on the monitor. What is the appropriate action?

1. Increase the dobutamine because tachycardia means better pumping
2. Stop all IV fluids to reduce the load on the heart
3. Give nitroglycerin to slow the heart
4. Notify the prescriber because the dose may need reducing

Answer: D) Notify the prescriber because the dose may need reducing. Dobutamine increases contractility but can cause tachycardia and arrhythmias, raising myocardial oxygen demand. The prescriber is notified to adjust the dose, which is not changed without an order.