Need feedback

Medwynn · Feb 27, 2008

In certain situations I have had to give Levo wide open at the max rate. One instance was when Pt came up from the ER with no pressure, faint fem and carotid pulse but with a 70 HR. The person didn't make it.

But we had an order for levo to be started, of course titrate to effect.

gcj95 · Feb 27, 2008

Hi there, No, I have never seen Levo wide open. I have seen Dopamine come up from the ED wide open not even on a pump... but that's another story.

G :specs:

Dinith88 · Feb 27, 2008

Hi, I'm new here and have an important question. Has anyone here ever seen a nurse give levophed wide open to a patient with a BP of 40/16 & HR of 114? And, seen a medical resident looking on and saying nothing about it?

Yes. During code situations. At this point it's typically a lost cause...so wont really hurt anything. Patient died right? (if not then maybe wide open levo 'helped' ?? )

Were you expecting the resident to yell and shout? For what purpose?

meandragonbrett · Feb 28, 2008

Yes, I have run levo wide open.....when doing surgery at the bedside and in the middle of a code. Why do you ask? Why would a resident say anything about this situation you have described?

CVICURN2003 · Feb 28, 2008

Uhhhh...yeah. USUALLY it is on a pump and combined with vasopressin (usually IVP per CRNA or MD) and epi and a code cart, chest cart and a cracked chest ....you get the picture...I would not leave it "wide open" not on a pump for an EXTENDED period of time but by then the pt is stablized, back in OR or dead. I ran levo at 50 ml/hr double strength today...

MayisontheWay · Feb 29, 2008

I asked one of our surgeons the other day if he had a max levo infusion rate .."whatever keeps 'em alive" was his response. Obviously he meant there are extreme conditions and it sounds like you witnessed one.

May

meandragonbrett · Feb 29, 2008

When you get up to dosing that is approaching 100mcg/minute, it's really not going to make much difference whether you're at 90 or 100mcg/minute. They become so catecholamine engorged, that a good deal of their circulating volume turns into continuous levophed. We don't go over 100mcg/min per policy. I HAVE run it higher though while doing an ex-lap at the bedside.

Dinith88 · Mar 3, 2008

They become so catecholamine engorged, that a .

'catecholamine engorged' :up: Thats a phrase i'm gonna start using!...

And by the way, an ex-lap at the bedside is about as hard-core as it gets! :smokin:

meandragonbrett · Mar 3, 2008

'catecholamine engorged' Thats a phrase i'm gonna start using!...
And by the way, an ex-lap at the bedside is about as hard-core as it gets!

I like it too!

Yeah, the bedside surgery that we do (on a regular basis it seems) is cool and hard-core at first....but it gets old after a while because it just screws up your your entire night as far as planning and organization, lol.