Inotropes - ICU Drips

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In this lesson we continue talking about ICU drips and take a look at a unique class of medications call Inotropes. We start off talking about what inotropes are, primarily a class of medications used to increase the contractility of our patients hearts. We also talk about the 2 primary ways in which medications can achieve this effect.
Starting with a group called catecholamines, we cover how these medications cause an increase in our patients contractility, and thus cardiac output and then move in to talk about different medications within this class, covering the concentrations and dosages that you would expect to find. Of these medications, Dobutamine is the only one that is going to be used solely and primarily for this effect.
Next we talk about a unique group within this class called the Phosphodiesterase Inhibitors and we explain how quite differently these medications can lead to an increase in our patients contractility, as well as the vasodilatory effect they have on blood vessels. Here we primarily talk about 1 medication called Milrinone, which is another drug that we use specifically for its inotropic effect.
Hopefully after watching this lesson you will have a better understanding of what this class of medications are as well as some of the differences between these medications and how they achieve their effects on improving contractility.
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Don't forget to check out the playlist for this series of lessons here: • ICU Drips
Also check out these other great lessons and series of lessons below!
Hemodynamics Principals: • Hemodynamic Principals
Shock: • Shock
Arterial Blood Gases: • Arterial Blood Gases (...
ECG/EKG Rhythm Interpretation: • ECG/EKG Interpretation
Heart Failure: • Heart Failure
Endocrine System: • Endocrine System
Blood Tubes - Order of Draw: • Order of Draw and Addi...
Glasgow Coma Scale: • Glasgow Coma Scale (GC...
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#ICUDrips #Inotropes #ICUAdvantage

[@ICUAdvantage]

🎓‼ Earn CE Credits! Pre-order ICU Advantage Academy: 👉🏼 adv.icu/academy 💲 10% off Critical Care Academy (CCRN Review): 👉🏼adv.icu/cca (USE CODE "icuadv10") 💲 10% off EACH Month @ Nurisng Mastery membership: 👉🏼 adv.icu/mastery 📝 NOTES available to members! ► KZbin: adv.icu/ym | ► Patreon: adv.icu/pm Thank you guys so much for watching! Please leave us a like if you enjoyed the video. We truly do appreciate it! Also we love hearing your comments so feel free to tell us what you think of this video, or even just to say hi! :) Check out the rest of the videos in this series here: kzbin.info/aero/PL2oVjKTYocdPLrS0odnyih8wf6zZ7WfVW Don't forget to check us out and give us a like on Facebook & Instagram as well! facebook.com/ICUAdvantage instagram.com/ICUAdvantage

[@amythestcalm]

I am a former ICU nurse and am enjoying listening to your videos. There is so much information to get updated on and I really like the reminders and learning since I am no longer at the bedside. Thank you!

[@ICUAdvantage]

Glad to hear you like them Carol!

[@nancycox473]

I’m an RN needing a refresher in cardiac medications, looking to up my game for cardiac stepdown and telemetry unit. Great lesson.

[@ICUAdvantage]

Awesome! Glad you liked the lesson. Theres many more in this series that might be beneficial to you as well as some of our other series might be good for you. Check out the lessons on Hemodynamics, Shock, and Heart Failure :) Thanks for stopping by!

[@josephmartinez8166]

I've dealt with Milrinone and didn't know what it was. I now understand the purpose and the class of medication it is. Thank you for clearing this up for me.

[@josharndt6360]

Your videos are amazing man. So glad I found this channel, you have a true gift of explaining complex medical topics in an easy way to understand.

[@ICUAdvantage]

Wow, thank you so much Josh! That is truly the whole goal of this channel and great to hear I am able to do just that! :)

[@WaitThatsNotRight]

Eddie, thank you for taking such involved topics and breaking them down into easy to understand lessons. I’m new to the ICU (after a long stint in med/surg) and your channel has helped me get a grasp on everything ICU.

[@ICUAdvantage]

I'm really glad to hear they have come across in a way that I was hoping. I try my best to make the topics understandable. They really are easy to grasp if explain the right way. The practical side, certainly takes time and practice. Glad they have been helpful for you though!

[@hassanhammoud3325]

So helpful always. Making adaptation to the Icu so easy. Content really interrelates with each video, absolutely awesome

[@ICUAdvantage]

Thank you for taking the time to leave a comment! Really happy to hear this. I do my best to try and tie everything together when I can.

[@hopeforkids7194]

thank you for these lessons. i am studying from your videos. its so very helpful and easy to understand.

[@aminahnadeemzafar4099]

This is incredible . amazing . spellbinding .i cant tell u how thankful i am as a med student for these vids

[@ICUAdvantage]

Haha this is awesome. I appreciate the kind words and glad you find them helpful.

[@TheWanderingDove]

SO thankful for your channel!! Its super helpful!

[@ICUAdvantage]

So awesome to hear this!

[@kaykaie1]

These are literally the best lessons I've utilized as I am reviewing critical care meds as I"m going back to the ICU after over a year. I'm in a masters program for my NP degree and I am totally going to refer to your videos for studying too! Thank you

[@ICUAdvantage]

Congrats Katie! So glad you find these videos useful and welcome aboard!

[@angelaryals431]

Super helpful video!! I’m the World’s Oldest New Grad, New ICU nurse. I would be even more lost and overwhelmed without your videos!! Thanks so much!! 🥰🥰

[@ICUAdvantage]

Hey its never too late! :) Really happy to hear I have been able to help!

[@mkragan12]

Thanks for this! I wanted a quick review of inotropes and that's what I got!

[@ICUAdvantage]

Fabulous! :)

[@jasonalberto1550]

I a newly registered nurse working for Emergency Department but this is really a big help since I didn't have much discussion abt inotropes during college! Will watch more from this Channel!

[@ICUAdvantage]

Awesome to hear this Jason! Glad this was useful for you and hopefully you'll see some other useful videos too! Thanks for taking the time to leave a comment.

[@hayatbenhasan9875]

Thank you for this review

[@africangirl6225]

Thank you very much for this amazing vedios.. I will definitely be listening to them frequently. Great Job

[@ICUAdvantage]

You are very welcome!

[@nursingschool-mt6ll]

this channel is AWESOME

[@hariniosh]

thank youuuu for this video!

[@gilliandebruin1166]

Just started in my high care unit 🙏 you amazing.

[@ICUAdvantage]

Congrats on the new position! And thank you!

[@queensukie23]

Thank you for this!

[@ICUAdvantage]

You're welcome! Glad you liked it.

[@camostorm]

Great info as always!

[@ICUAdvantage]

Thank you sir!

[@nursep18]

Thank you!!

[@ooommm4024]

thank you, eddie, for this review. i am trying to return to work as an rn, also.

[@ICUAdvantage]

You're welcome and best of luck as you return to work!

[@bmsmmeminem]

I hoped you included Levophed as well as epinephrine but your lesson was amazing thank you

[@ICUAdvantage]

Thank you Bonnie. I previously discussed Levo and Epi in the vasopressor lesson which was done before this lesson. And I made mention of them here as they certainly do have inotropic effect (epi especially) but this lesson I wanted to focus on the medications that are truly considered inotropes in their category and that we use primarily for inotropic support.

[@marjanmathilda1475]

Thank you !

[@darrenhirst9900]

Thank you for the videos they're apricated.

[@ICUAdvantage]

Thank you so much! Truly my pleasure!

[@mordechaikiewe4871]

Coming in in the clutch as usual Thanks

[@ICUAdvantage]

Haha thanks so much!

[@isisvanderpaardt5861]

Hi Eddie! I really enjoy your videos and was hoping to make a special request! Would you mind doing a series on CRRT? I have taken care of a lot of patients on CRRT, but because I am a new graduate RN I feel as if there is more useful information or insight you could provide regarding this treatment modality. Keep up the awesome work! Thanks

[@ICUAdvantage]

Hey Isis! I actually am doing CRRT very soon!

[@ericbishton2779]

I’m a paramedic that’s interested in critical care. These videos are helpful in learning about ICU treatment. I real like and appreciate your videos! Sometimes the smaller writing in some videos is harder to read on my phone. Why no mention of norepinephrine as an inotrope?

[@ICUAdvantage]

Thanks so much for taking the time to leave a comment Eric! I'm so glad that you are finding these videos to be useful for you. I'm always happy to hear that people enjoy them. Always open to suggestions to add to the to-do list as well. I can certainly see how the small writing would be hard to read on a phone. I certainly have made them with the intention of viewing on a computer, but I'll certainly take that in to consideration for future lessons. As far as not including Levo in this lesson... in my experience, rarely is levo being used for the inotropic effect. While the benefit from it is certainly there, which I tried to make that point when mentioning about the catecholamines, in practice I've found that most often the main benefit for why providers are choosing levo is for its vasopressor effect. There are times that levo is chosen over other pressors BECAUSE of this increased inotropy, but if our big focus is on increasing contractility, then we typically gravitate towards these other medications. If we need strong inotropy AND vasopressor effects, more often I see epi being used in these cases, as it has a markedly greater effect than levo. Hope that clears things up a bit! Thanks again for stopping by and look forward to seeing you around more!

[@cristinavasta8014]

Great lesson

[@ICUAdvantage]

Thank you very much Cristina! So glad you liked it.

[@123456789inferno]

Would you be able to make a video on using insulin for inotropic effects in CCB overdoses?

[@prof.dr.huseyinbozbas498]

Certainly very useful

[@ICUAdvantage]

Glad to hear that!

[@Xalliumm]

Would love you to make this into podcasts as well so I could lock my phone and listen!

[@ICUAdvantage]

One day when I have more time!

[@hanyelblasy]

Thank you so much, would you mind explaining the role of norepinephrine as inotropic?

[@ICUAdvantage]

I did talk about it a little in the vasopressor lesson as that is primarily where I covered norepinephrine. I will probably do a CC Meds lesson on Norepi in the future.

[@jonl1319]

I'm a student about to go into my 4th semester but really want to be on an ICU floor when I graduate. I really love the videos here they are put simply and aren't too long. I did have a question though for Milrinone you said the concentration is 1mg/10ml so it would be found in 5/50, 20/200, and 40/400 correct? Or am I missing something?

[@ICUAdvantage]

Good eye! I should have put 1-2mg/10ml. In fact, we typically only use the 100ml bag which has 20mg at my hospital. Eventually you'll learn the concentrations specifically for what you have available at your hospital as some of the medications truly come in many different premix volumes and concentrations. Best of luck to you! You're almost there!

[@amirhil5218]

hey ! thanks you .but what about norepinephrine ?

[@ICUAdvantage]

Its in the vasopressor video for this series 😊

[@lizzieyann]

Easy mnemonic for cathecolamines: EDDI 😊

[@ICUAdvantage]

Haha, if only there was one more E medication! 😊

[@NajmetAylol]

Wonderful

[@ICUAdvantage]

Thank you

[@venkybly]

Tq

[@ICUAdvantage]

yw

[@micheleroberts4964]

Hello, I just graduated nursing school and I’m starting in the CVICU. I was wondering if there is a particular order I should be listening to these videos? I’m trying to find anything and everything to help me learn and transition into this role. Any suggestions?

[@ICUAdvantage]

Hey congrats Michele! Very exciting. The CVICU is a very interesting place to work. Lots of cool toys and very sick patients. As for an order, I don't know if there is necessarily. I would just browse the playlists and then watch from start to end in the playlist. If there are lessons that build on each other, they will be in the right order in the playlist. Hemodynamics Principals will be a good one for you if you haven't watched those.

[@dominiquek.9376]

is there a video on isoproterenol at all?

[@ICUAdvantage]

Not yet, but soon

[@chadrichards4681]

This is like Kahn Academy for doctors.

[@ICUAdvantage]

Khan Academy was part of my inspiration for style! I like to think of it as Khan Academy style for critical care!

[@cefpicu6111]

wow

[@ICUAdvantage]

ty

[@newmai85]

When you write Epinephrine 1mg/250ml pls do specify and calculate everything in ml for doses so that we are not confuse

[@ICUAdvantage]

I'm not sure what you are asking. I list out the common preparations that we find the medications as these are important to know.

[@newmai85]

ICU Advantage : what does 1mg/250ml means ?

[@newmai85]

ICU Advantage : Noradrenaline comes as 4m/4ml. Do you mean 1ml in 250 ml of 5% dextrose ? your 1mg/250ml is confusing me. Don’t take it other way. May be you can make it easier for me to understand 🙏

[@newmai85]

4mg/4ml

[@ICUAdvantage]

@@newmai85 Yes. I think you are referring to whats in the vial. Then we add that to a 250ml bag of saline typically. For Levo (Noradrenaline) we typically have 8mg in a 250ml bag a saline to infuse via IV pump.

[@jillgoldman4226]

“Old practice with old nurses” , sounds a bit like Millennial snobbery. Watch that kid, we are all in this together.

[@ICUAdvantage]

What on earth are you talking about?

[@jillgoldman4226]

ICU Advantage Listen to your video. The quote comes directly from your own statement. I’ve been a nurse since 1979 and I often feel the younger nurses are ok with statements such as that. In case you don’t remember the content, you said it in reference to reverse trendelenberg positioning for hypovolemia. That is what on earth I’m talking about.

[@ICUAdvantage]

Well considering that you referenced something from a completely different video, that explains the confusion. I'm sorry that you are finding some reason to feel personally attacked by that statement, but the fact remains that its an antiquated practice that has been proven to have detrimental effects. It wasn't meant as an attack on anyone, but thanks for taking the opportunity to do just that yourself.

[@ritz1291]

@@jillgoldman4226 It is antiquated, and not best practice. You shouldn't be mad at that fact because it is unsafe and i still see people doing it. This is just like gastric residuals, in which some people still do it, even tho its not best practice. And i know, some providers write specific orders for it, but its not something that has fully phased out of our practice. Move forward, and accept new thoughts.

[@jasony8002]

Appreciate it

[@ICUAdvantage]

Glad you liked it