Norepinephrine (Levophed) - Critical Care Medications

[@ICUAdvantage]

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[@wendybarcelo2078]

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These videos are incredible. I recently switched from ED to CVICU and I’m very overwhelmed. These are good to supplement learning from work.

[@ICUAdvantage]

Wow so great to hear these have been so helpful for you. It definitely is a different world in the ICU but it gets better with time. You got this!

[@tfroadrunner]

I'm recently retired, but forwarding some of your videos to my daughter in law who is just starting in ICU, from mother/baby. Your presentation is always awesome.

[@ICUAdvantage]

Very cool! Congrats on the retirement and thanks so much for helping to spread the word to the new generation. Glad to hear you like the videos and hope they can be of help to your DIL.

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I’m a resident at a small ICU setup, i found these icu advantage videos really very informative. Thankyou

[@ICUAdvantage]

Very cool and glad you are finding the videos helpful!

[@Thomas-vq1ox]

I floated today to the ED to help with boarded patients and had my first Levophed drip. This is awesome to reflect on my day as I am by no means a critical care trained RN. Thank you for explaining it to me so well, it helps me decompress and digest what just happened!

[@shegotit143]

That seems unsafe 😅

[@gregcody9957]

Don’t think they should have given you an icu pt if you’re not a cc nurse!

[@Thomas-vq1ox]

@@gregcody9957 There was another nurse thankfully that was watching the patient with me so they were definitely having me on a leash! 😅

[@chopsticksforlegs]

Thanks for helping out in ED. A LOT of ward nurses refuse to come down.

[@gay8836]

I’m a CNA and saw this being given via intraosseous access, thanks for the lesson !

[@YiiTheIceLatte]

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[@cshaw_4201]

I’m loving these videos!! Trying to understand these medications even further is proving helpful when preparing for CRNA school

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Did you get in?

[@paigetaylor803]

Thank you so much! I just started as a new grad in the ICU and your videos are incredibly helpful.

[@kikomagana1990]

You are really getting me and the school wife ready for the ICU. Thank you for these! Picked up two stickers.

[@ICUAdvantage]

Haha awesome! Happy to help. And thanks for the sticker support. Have you received them yet?

[@XydhaneArmani]

I am just starting again working in ICU and I find your videos very informative. Looking forward to learning more from your videos. Thank you!

[@Roe344]

Thank you. Very informative and clear explanation. 👍

[@ICUAdvantage]

Glad you thought so!

[@brucey1905]

Just stumbled across this channel... Great delivery platform of clear, straight to the point understanding on Levophed in under 10 mins! Thanks for posting! Subscribed!👍🏻

[@ICUAdvantage]

Awesome! Welcome aboard. Glad you enjoyed the video.

[@ruthelizabeth1639]

Just found your channel! I’m an ICU nurse in the UK and your videos are so helpful, thank you!

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The class was helpful really... Thank you

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Great Videos, in nursing school and these are very very helpfu!

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Happy to hear it! Best of luck in your studies

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All your are classes very helpfull to add on knowledge in our daily practice.. thank you so much for all your efforts

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Truly my pleasure and really glad to hear this!

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I might be starting my ICU nurse residency program next month and this channel was recommended to me to help prepare. I’ve learned a lot so far. Thank you so much the content! I’ll def be spreading the word to other new grads looking into critical care :-)

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Good luck with your program

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@@givinguponmyself1179 thank you, I appreciate it!

[@ICUAdvantage]

Congratulations Sabrina! How exciting! Really happy that the channel was recommend to you and you are finding it helpful. Also a huge thanks for helping to spread the word as well. I really appreciate you!

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Great lesson

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We need more video like this🎉

[@vicenciodavila7464]

Incredible videos. Really helpful bridge to book chapters. Saludos desde Argentina!

[@ICUAdvantage]

Very cool! Glad you liked it!

[@aboa6217]

Dear, Thank you so much for your time and video Could you please make a video about peripheral blood smear specially WBC count and how to make comments for CBC results (PBS)? Kind regards,

[@ICUAdvantage]

Thanks for the suggestion. I do have plans for stuff like this on the todo list.

[@chaikristinjournals]

Haven’t watched the video yet but my first thought was ahh yes levo, one of the main differences between us in critical care and the floor. We can just slap on a levo for a patient and even call the pharmacy for emergency levo even without an order but on the floor it’s always a big thing with a rapid response, transferring to the unit, etc

[@mamushrete1540]

Great stuff!

[@MrCRISPONATOR]

How much of an effect does Levo have on Beta 2 receptors. In the vasopressors video it was stated that there was not an effect but in this video it says there is a Beta 2 effects. Thanks!

[@mahadshabbir7519]

LOVE THESE LESSONS! KEEP IT UP!

[@ICUAdvantage]

Awesome! Will do!

[@tsouksomvang]

Great lesson !

[@Sj-ct4sr]

Very helpful 👌

[@رؤىبارعدي]

Thank you for that amazing informations ..can ask a question? If the pt have low BP but high HR is that a contraindication of using Amiodarnoe

[@ICUAdvantage]

Not necessarily. If the low BP is due to the fast HR, then slowing the rate should improve the BP.

[@رؤىبارعدي]

@@ICUAdvantage thank you that help me alot.the pt was in compensated stage of shock and the increased HR was due to high grade fever (septic shock ?! And the BP became normal after corrected the HR by lowering the temperature as you said .god bless you

[@sheridanrobbins3956]

I am an Australian emergency nurse and we use Metaraminol as our first line peripheral vapsopressor especially in sepsis as bolus’s then commencing infusion if required. Do you use this medication? NORAD is normally our second line med.

[@Adityadraw]

I am Indian nursing officer

[@anuraj42]

Can you explain what is Noradrenaline base ? How should we prepare the solution, based on Noradrenaline bitartrate or base dose ?

[@ICUAdvantage]

I’m sorry, I’m not sure I understand what you are asking.

[@barbaracherrington375]

Awesome lesson. 👌. Thanks.

[@ICUAdvantage]

Really happy to hear this! You're welcome.

[@maddikuntasravansuraj5000]

Good information 👍👍👍

[@ICUAdvantage]

Thank you so much. Really glad you liked it!

[@abudaniyal715]

Thanks

[@miyoungso1355]

Hi. Would you be able to explain why hypernatremia happens on Critical pt? Dehydration is already addressed.

[@thefunctionalfarmacista7790]

Recently they had a patient on a levophed drip and the dose was maxed out and patient needed more pressors, so they made an Epinephrine drip (which, I was not that familiar with…in terms of an Intravenous drip route).

[@ICUAdvantage]

Sounds like a sick one there. I did actually previously cover Epinephrine and talked about it as a drip in there too. I’ll include a link to that. kzbin.info/www/bejne/ipKpqp14f6l3pNU

[@thefunctionalfarmacista7790]

@@ICUAdvantage thank you ❤️🙂🙂

[@kaiko2600]

@@ICUAdvantage What is commonly used next if Levo and Epi aren't working?

[@IVIorpho]

@@kaiko2600 I commonly see Neosynephrine and Vasopressin used if necessary

[@breezy30153]

@@kaiko2600 dopamine

[@tttony9426]

question, 95 year male in ICU with difficult breathing,patient was given many bags of levo. before vent,was installed,patients heart stopped from multiple bags of levo then passed,is this normal procedure ,???

[@Justsaying121]

I'd love to work in the ICU but just find staff to be rude, competitive and gossiping about each other too much. Though it sounds so interesting and informative. I wish I had the ICU attitude so I'd be able to fit right in 😅

[@dgmnhn2098]

Thanks !

[@ICUAdvantage]

Welcome!

[@waynepalmar6101]

Great thanks

[@firstladyusgh9014]

Thank you

[@yairyair8784]

But isn't norepi only functional on Alfa1/1 and beta 1 ? How is it an agoinst of beta 2 ??

[@twominuteanaesthesia]

Good content

[@kikomagana1990]

What about norepi in hypovolemic shock? Some literature I’ve seen warns against norepi in hypovolemic shock so I’m a little confused. Hope you reply to this. Thank you!

[@ICUAdvantage]

So, ideally for hypovolemic shock, we generally have no problem with squeeze and its all related to the volume loss. Therefore, we really need to replace volume to resolve the shock. So whether that be fluid or blood, that is really the best treatment. That said, sometimes we are waiting for resolution from fluid administration and we will use a pressor to help with the squeeze to improve MAP, but that should be temporary. Again, the body is constricting vessels pretty well as a result of compensation mechanisms, but we can aid that a little more with something like Levo, but again, we really just need to replace the volume asap.

[@alyssasalinas4905]

what can happen if you start levophed too fast?

[@JLS1994]

We call it noradrenaline in Australia

[@ICUAdvantage]

Always find it interesting how we do things different than the rest of the world lol

[@lobarita]

Back with another like.

[@asimrph]

Hi ICU Advantage ! Can you please tell me which software do you use for making your video. Waiting for your reply. Regards.🌼

[@ICUAdvantage]

Photoshop on a Mac, screencast to an iPad with Apple Pencil.

[@peruviangentry2738]

Well explained! 10\10 would do drugs with this guy 😎

[@ICUAdvantage]

😂 glad you enjoyed it!

[@soocelacrackel8053]

Educational since 😅my husband lost his life having sepsis.

[@bbrain1160]

Does NA act on beta-2 receptors? For exsample, if NA is administrated extravasally it can cause tissue necrosis

[@ICUAdvantage]

Yes it does have an impact on Beta-2 and yes if infiltrated can lead to tissue necrosis. Regetine is the treatment for extravasation but I’ve never personally seen it used.

[@anonymous-td2wy]

I need to see how it’s titrated in the pump too

[@ICUAdvantage]

I don't usually cover specific equipment as that stuff varies so much. I try to cover foundational stuff that can be then applied to whatever equipment you use.

[@Rok3469glazer]

Those who know💀

[@jonathanmclean5807]

???

[@andreawong5225]

Thank you,Eddie for such detailed teaching. Is there or what's the proper safe rate of weaning down the Noradrenaline by per hour?

[@LEdHeadW]

At my hospital we usually wean by 0.02 mcg/kg/min q 5 minutes.

[@ICUAdvantage]

Hey Andrea! So depending how your titration orders are written I would just titration down as ordered. Usually every 5 mins as the above person mentioned. Just titration down as their pressure tolerates it and hold if your pressure gets near your goal. If you end up pretty close to your goal you can try leaving them for 15-30 mins and see if they hold and then try the next step down. Sometimes they need to stabilize at a certain level and even though they are at or near the MAP goal if given times sometimes you can do another little step down and again let them stabilize. If they don’t tolerate it then back up you go. If you have more free range in titration I did link to that other lesson where I gave some pointers on titration that may be helpful.

[@andreawong5225]

@@ICUAdvantage thank you😊

[@andreawong5225]

@@LEdHeadW thank you for the share😊

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This channel is a blessing. Do you have Instagram?

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ty

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Where are the notes ?

[@ICUAdvantage]

They are available to the KZbin and Patreon members.

[@itsmepranay2647]

Tell me Formula of dose calculation

[@davidhammond10]

Good videos but the constant commercials kill it!

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[@dgmnhn2098]

Thanks !

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Ty