Levophed Bolus

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Specializes in EP/Cath Lab, E.R. I.C.U, and IVR.

Recently during a code situation that involved a pt's RCA and V-Fib we maxed out on our Neo gtt, Epi gtt, and Levo gtt. We were then giving 3-5 minute bolus of epi and neo just keep his pressure up. I requested to the MD that we give a Levo bolus and suggested 32mcg or 2 mls. The bolused worked wonderful. Has anyone else seen this occur or heard of a Levo bolus.

Jonathan RN

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Specializes in ICU.

How did that whole deal turn out?

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I haven't heard of levo boluses before. I'd would think not much else would work if you had maxed out your epi.

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Specializes in ICU.

I was talking to a cath lab nurse and she told me about a time the patient was practically dead, and she asked the doc about trying a nice Neo bolus. It worked, BP and good strong pulse came back.

Sometimes when death is the other option, you find out some crazy things work!

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Specializes in ICU.

I gotta think that if you're bolusing Levophed, then you've been going at it for a while. How did that case turn out?

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Specializes in critical care, PACU.

I saw this done multiple times on one patient. It was incredible. He was seconds from coding, had more than thirty blood products in twelve hours. He was in continuous VTach for like forty five minutes but kept his pulse and he made it through the rest of the shift, but of course it was a hopeless scenario and he died that day.

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Specializes in EP/Cath Lab, E.R. I.C.U, and IVR.
How did that whole deal turn out?

The pt's BP went throught the roof from 40-50s to 180 and never dropped back down below 110. We decreased his all of his gtts. The patient survived.

Jonathan RN

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Specializes in Emergency, Trauma, Critical Care.
The pt's BP went throught the roof from 40-50s to 180 and never dropped back down below 110. We decreased his all of his gtts. The patient survived.

Jonathan RN

What a trip! Good to know :)

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

levophed is the closest thing to epinipherine without resorting to a epi drip....sick hearts love epi!!!!

norepinephrine (abbreviated norepi or ne) is the us name for noradrenaline (abbreviated na or nad), a catecholamine with multiple roles including as a hormone and a neurotransmitter. areas of the body that produce or are affected by norepinephrine are described as noradrenergic.

the terms noradrenaline (from the latin) and norepinephrine (derived from greek) are interchangeable, with noradrenaline the common name in most parts of the world. however, to avoid confusion and achieve consistency medical authorities have promoted norepinephrine as the favoured nomenclature, and this is the term used throughout this article.

one of the most important functions of norepinephrine is its role as the neurotransmitter released from the sympathetic neurons affecting the heart. an increase in norepinephrine from the sympathetic nervous system increases the rate of contractions.

as a stress hormone, norepinephrine affects parts of the brain, such as the amygdala, where attention and responses are controlled. along with epinephrine, norepinephrine also underlies the fight-or-flight response, directly increasing heart rate, triggering the release of glucose from energy stores, and increasing blood flow to skeletal muscle. it increases the brain's oxygen supply. norepinephrine can also suppress neuroinflammation when released diffusely in the brain from the locus coeruleus.

when norepinephrine acts as a drug it increases blood pressure by increasing vascular tone (tension of muscles) through α-adrenergic receptor activation. the resulting increase in vascular resistance triggers a compensatory reflex that overcomes the direct homeostatic effect of that increase on the heart, called the baroreceptor reflex, which otherwise would result in a drop in heart rate called reflex bradycardia.

norepinephrine is synthesized from dopamine by dopamine β-hydroxylase. it is released from the adrenal medulla into the blood as a hormone, and is also a neurotransmitter in the central nervous system and sympathetic nervous system where it is released from noradrenergic neurons in the locus coeruleus. the actions of norepinephrine are carried out via the binding to adrenergic receptors

http://en.wikipedia.org/wiki/norepinephrine i am liking wiki more and more.....great explanation!!

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I've seen a kid brady down with Levo bolus' before, like HR of 30-40 which self-resolved after about 5 minutes each time.

Not so sure I'd be comfortable with that, but like was mentioned, when the other option is death, I guess it's worth a go!

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I've seen a kid brady down with Levo bolus' before, like HR of 30-40 which self-resolved after about 5 minutes each time.

Not so sure I'd be comfortable with that, but like was mentioned, when the other option is death, I guess it's worth a go!

With children the med choices are different because the are built different as the administration of a narcotic can cause a paralysis/stiffness of the chest and make it difficult to ventilate them......

Quick IV boluses are commonplace in the OR and are reffered to a s "giving a wiff" of xyz.....especially when removing a patient from pump. Levo is similar to epi and depending on where you are in the country is what drug is used. I worked with a group of MD's that would give epi first and we called it leave em dead levophed.....when I moved to another state they about had a stroke when I mentioned epi....:D

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Specializes in EP/Cath Lab, E.R. I.C.U, and IVR.

All I know is that this was a lot of Alpha to have Neo, Epi and Levo.

Jonathan

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