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Diseases & Conditions, 2002 Diluent: LEVOPHED should be diluted in 5 percent dextrose injection or 5 percent dextrose and sodium chloride injections. The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgement. An infusion of LEVOPHED should be given into a large vein (see PRECAUTIONS). https://criticalcaremedicine.pbworks.com. Ether way the MDPB spent time, energy, and brain power deciding on these. While I'm still an Advance I'm not getting that training but I like to harass medics so hopefully I'll know how to work them by then. Usual dose is 0.03-0.25 μg(mcg)/kg/min. It is. should not be titrated due to ischemic effects, Possible increased inotropy, cardiac use of ATP, Inhibits NO mediated peripheral vasodilation, Goal is to reach critical organ perfusion pressure, IV Vasopressor have not been shown to be unsafe when used peripherally, Increases heart rate and inotropy and vasoconstricts, 10 cc syringe with 9 cc of NS and draw up 1 mL of 1:10,000 epi (cardiac epinephrine with 10mL of 100 mcg/mL which is 1 mg of epinephrine), Use 0.5-2mL (5-20 mcg) every 1-5min (similar to epinephrine drip), Can give peripherally since similar concentrations are give subcutaneously with lidocaine with epinephrine (1:100,000), Effects are usually gone within 5 minutes, Pure α (no effect on heart) potent vasoconstrictor, Useful in tachycardic patient since no effect on HR and might even decrease from reflex parasympathetic response, Increase in heart perfusion can improve cardiac output, Now have 100mcg/mL with total bag containing 10 mg of phenylephrine, Use 0.5-2mL (50-200mcg) every 1-5 minutes, Can give peripherally since drug is approved for IM or SQ use, Avoid hand/wrist and ensure peripheral IV quality before starting vasopressors, Push dose epinephrine and phenylephrine have low chance of causing extravasation injury, Prevention - phentolamine mesylate 10mg into each liter of norepinephrine solution (pressor effect is not changed), If the pt is relying on the agent for their hemodynamics, switch the pressor to another IV or place an immediate IO or central line, Administer subcutaneous phentolamine mesylate (Regitine) using 25 G or smaller needle, A dose of 0.1 to 0.2 mg/kg (up to a maximum of 10 mg) should then be injected through the catheter and subcutaneously around the site, Administered as soon as the extravasation is detected, even if the area initially looks just a little white or OK, Should see near-immediate effects; otherwise consider an additional dose, May cause systemic hypotension (but they should be on pressors at another site). NEJM 363(9). Initial: 8-12 mcg/min IV infusion; titrate to effect, 0.01-3.3 mcg/kg/min IV infusion (Hollenberg 2009), Should be titrated to age-appropriate blood pressure, Initial: 0.05-0.1 mcg/kg/min IV infusion; titrate to effect, 0.05-0.1 mcg/kg/min IV infusion; titrate to effect; not to exceed 2 mcg/kg/min, Dyspnea, with or without respiratory difficulty, Antidote for extravasation ischemia: To prevent sloughing and necrosis in areas where extravasation has taken place, infiltrate areas promptly with 10-15 mL of saline solution containing 5-10 mg of phentolamine mesylate for injection, Use syringe with fine hypodermic needle, with the solution being infiltrated liberally throughout the area, which is easily identified by its cold, hard, pallid appearance, Patients who are hypotensive from blood volume deficits except as an emergency measure to maintain coronary and cerebral artery perfusion until blood volume replacement therapy can be completed, Peripheral vascular thrombosis (except for lifesaving procedures), Concomitant use with some general anesthetics cyclopropane (not available in the US), halothane (not available in the US), If therapy is continuously administered to maintain blood pressure in absence of blood volume replacement, severe peripheral and visceral vasoconstriction, decreased renal perfusion and urine output, poor systemic blood flow despite “normal” blood pressure, tissue hypoxia, and lactate acidosis may occur, Use extreme caution with concurrent monoamine oxidase inhibitor (MAOI) use or antidepressants of the triptyline or imipramine types; severe, prolonged hypertension may result, Cyclopropane and halothane anesthetics increase cardiac autonomic irritability and seem to sensitize the myocardium to action of intravenously administered epinephrine or norepinephrine, Not for use in profound hypoxia or hypercarbia, Bitartrate injection contains sodium metabisulfite, a sulfite that may cause allergic-type reactions including anaphylactic symptoms and life-threatening or less severe asthmatic episodes in certain susceptible people, Because of potency of drug and because of varying response to pressor substances, possibility always exists that dangerously high blood pressure may be produced with overdoses of this pressor agent; it is desirable, therefore, to record blood pressure every two min from time administration is started until desired blood pressure is obtained, then every five min if administration is to be continued; rate of flow must be watched constantly, and patient should never be left unattended while receiving therapy; headache may be a symptom of hypertension due to overdosage, When possible, infusions should be given into large vein, particularly an antecubital vein to reduce risk of necrosis of overlying skin from prolonged vasoconstriction; some authors have indicated that femoral vein is an acceptable route of administration; occlusive vascular diseases (for example, atherosclerosis, arteriosclerosis, diabetic endarteritis, Buerger’s disease) are more likely to occur in the lower than in the upper extremity; one should avoid the veins of the leg in elderly patients or in those suffering from such disorders; gangrene has been reported in a lower extremity when infusions were given in an ankle vein, Infusion site should be checked frequently for free flow; care should be taken to avoid extravasation of drug into tissues, as local necrosis might ensue due to vasoconstrictive action of drug; blanching along the course of the infused vein, sometimes without obvious extravasation, has been attributed to vasa vasorum constriction with increased permeability of vein wall, permitting some leakage, Lactation: Not known if excreted into breast milk; avoid use during breastfeeding.

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