Appropriate selection and utilization of vasopressor therapy are important in the treatment of vasodilatory shock, because inappropriate use can result in increased morbidity and mortality. Vasopressors are differentiated on the basis of their receptor activity, as well as their pharmacokinetic and pharmacodynamic properties. Understanding the pathophysiology of receptor responses in shock, dose-dependent receptor activity variations, and unique patient-specific factors that alter response, all assist the health care provider in selecting the appropriate agent for each patient. Treatment is further individualized on the basis of clinical response and medication titration, as well as laboratory value changes. The intent of this review is to discuss relevant management issues associated with vasopressor use in the emergency department.