[poppy07]

i always like that one, "just curious...if you could explain that to me for my own learning purposes!" It really puts them on their toes. Some attendings actually are grateful for these questions.

[lorilou22RN]

As with other posters we will go very high with Levo, I've seen upwards to 200 mcg, with vaso etc. Have to change the bag every 2 hours it was infusing so quickly at double strength (reg strength is 8mg in 250 at my facility). Sorry you were so freaked! sounds like a BADDD nite.

[lindszepplin]

Was an echo ever done? It sounds like it was more than a gtt issue.. was cardiac tamponade ever ruled out? if the systolic and diastolic were really that close.. sounds like tamponade to me...No amount of medication could have helped this - only a tap!

[foxyhill21]

Lifelongstudent: sounds like you work at a very very intense ICU, I would love that type of experience

Originally Posted by lifeLONGstudent

[To answer the original question: I had a patient not too long ago that was on 300 mcgs of Neo, 90 mcs of Levo (that was the DOCs set max, not our hospital policy max), 20mcg of Dopamine and 0.04 units/min Vasopressin. I started CRRT that night AFTER we went to CT (THAT was a fun trip!). Also had HCO3 gtt for a pH of 6.8.... Fentanyl and Versed for sedation (intubated). After 3 weeks in MICU, pt was on weaning trials, successfully extubated and moved out to the floor. I didn't think she would live through the night.... neither did the docs. Makes me think twice about ever deciding to withdraw on anyone in my family.



LifeLONGstudent

[lifeLONGstudent]

ohhh yaaaaaa.

[Conrad283]

I have only gone up to 15mcg's ( I have 1.5 months of exp ) but my wife says she's gone up to 64 mcg's.

[dittydo]

I have never thought of levo having a max rate. At my current facility, they were using 30mcg/min as the max. A yr ago, our new groupof intensivists became frustrated realizing that the staff were saying that the "levo is maxed out" based on the 30mcg/min. So we changed it to mcg/kg/min. It took a bit of education because the dosages are so different. The mcg/KG/min dose range is 0.03-3 mcg/kg/min. For a 75 kg pt, 3 mcg/kg/min runs at 850ml/hr. Inadvertently misplacing a decimal pt can make huge change in the dose. But because it's levo it will be noticed immediately.