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gangrene, ischemia, necrosis, norepinephrine, vasoconstriction, wound care



  1. Wilson, Michael BS
  2. Schafer, Kristin MD
  3. Goldschmidt, Eric MD
  4. Wu, Benita BS
  5. Simman, Richard MD, FACS, FACCWS


ABSTRACT: Norepinephrine is used in the acute care setting to establish and maintain hemodynamic stability in patients with hypotension. Although it is often a lifesaving medication, norepinephrine may lead to profound vascular insufficiency in the extremities, resulting in dry gangrene and skin necrosis. The purpose of this article is to present a case series of skin complications related to treatment with norepinephrine and review the pathophysiology behind these complications. The authors also explore risk stratification as it relates to history and clinical presentation with subsequent focus on contingencies to mitigate the adverse effects of vasoconstriction on peripheral tissues.