This is so great to hear. I'm really happy knowing that these are helpful for you! I really appreciate the kind words and for taking the time to leave a comment.
Just graduated in May and started on a stepdown unit. Our unit just started taking dopamine gtts, but no one is used to taking it and of course I got assigned a new admit on dopamine. Your video really helped explain the function of the medication and helped me care for my patient better!
Really enjoy your posts! I am a Paramedic with Grady and my wife is CCRN at Emory ICU and we enjoy watching and discussing your videos together. At Grady EMS We use Levo rather than Dopamine so looking forward to your videos contrasting these options. Thanks for posting.
Awesome man! I bet your arrangement makes for some interesting dinner conversations! lol Now, when you say you use levo rather than dopamine, in what context? I'm assuming for BP as a vasopressor?
Thank you for explaining why an injection of metoclopramide has posibly given me dystonisa and tardive dyskinesia.. Can you guys please be extremely careful when administering dopamine drugs please?
Dopamine isn’t used often but it’s also not uncommon in my icu. We usually use it for heart block patients and symptomatic bradycardia but it usually gets D/Cd soon after they get TVP wires it and implanted pacer from the CCL
Agreed. TVP is the way to go for persistent symptomatic bradycardia but every now and again will see it left running if pt well responsive, as well as the occasion CTS use for renal dose 🙄
I've read some studies (happy to find them if you'd like) that argue against the idea that Dopamine actually does have a 'renal dose,' and am curious what your thoughts are on that? It would make sense, physiologically, that it does, however there is talk amongst clinicians I've worked with in emergency/crit care who state that simply isn't the case and that mode of therapy is more old-school. Secondly, regarding its use for brady-dysrhythmias/hypotension: I've had medical directors in former EMS agencies with whom I've worked that have said its arrhythmogenic properties make it a terrible medication for use. Again, I can appreciate this as anecdotal, however at least in the pre-hospital field it's 'well-known' that Dopamine is rarely a drug we should reach for, if ever. I rarely see it in the cardiac ICU where I work currently, and when I do it is for the aforementioned renal-dose, but again I haven't noted a significant result when I've had patients on it for that reason. Would love your thoughts, and keep up the great work. your videos are awesome, thanks!
Yeah I've definitely seen the studies and the evidence seems pretty clear that renal dose is not of benefit and in fact can actually be detrimental. We do know it increases urine production. The question is, giving a dose that produces this without any added real benefit to perfusion, is that effective? The evidence seems to say no. That said, I've seen some very intelligent physicians who I trust, who still use it this way occasionally. As for its use in ICU, I do see it a bit for bradycardia, but short of throwing the kitchen sink and then some at people, I don't often see it used for shock. That said, it is a quick access in our code carts, so sometimes it is used out of convince in shock, but usually mixing up a levo, Neo, or epi drip doesn't take that long.
I am a new ICU nurse and your videos have been helpful to help me understand medications that are new to me. I wanted to clarify your opinion on what my preceptor taught me. Recently, I had a patient that was in a third degree heart block that occurred on a step-down unit. Initially, the patient was given atropine with no impact and then she was placed on a dopamine gtt @ 10 mcg (she received a TVP that night). Two questions, I was told that atropine is not effective for third degree heart block. Second, do you think Dopamine IS effective for third degree heart block? The patient was in and out of the heart block until the TVP was placed; however, I wasn't convinced that the medications were the reason she converted. As I didn't hear heart block mentioned in your video, I was curious! Thanks!
Great question. Dopamine and Epi are indicated to start for CHB, but usually they won't be effective and pacing is almost always required. Sounds like your patient had a transient block of the final conduction pathway hence the going in and out.
I'm protecting 90 year old alzimer+dementia patient.short time memory is too low.tell several times can force to 10m walk,eat ...sit or stay same position.talks well. But words (vocabulary)low.Is there any memory improving drug?--- you are doing good work to the world !
Great video thank you so much sir but some confusion you didn't talk about dopamine action on dopaminergic reseptor renal perfusion and increase urine output and also prevent cell injury.
Love, love your videos. Great information. I want to know why some critical care medications are not Great to be given via peripheral IV access. Thanks for your reply
Yay! So happy to hear this. So it often depends on the medication for some of the reasons, but pressors, which are the most common that this comes up with, are due to a few things. They are vesicants and irritants and are better served infusing in to a large vessel, aka central line. Also with those we run the risk of extravasation and potentially tissue necrosis if that happens. That said, if there is no other option, we absolutely will use peripheral IVs until we can get a central!
@@ICUAdvantage If it helps, a lot of times this has happened with our patients who are on sedatives--often precedex, but simultaneously on esmolol and several other IV medications. I'm sure hypoxia from Covid ARDS doesn't help either. At first it caught us off guard. We thought maybe there was some vagaling, but then it started happening without inline ETT suctioning. We used atropine, got hypertensive. Then in 30 minutes or so that rhythm would come back and then eventually one of us would get annoyed with that roller coaster and just start dopamine and cardene. Usually this would resolve after the patient switched sedation. But it was always a bit exciting when we first started sedating.
As a new nurse to ICU with many years of alternative nursing experience, I find your video's extremely helpful in my learning journey
Nurse Eddie Watson is making me a very smart ED RN❤
Beautifully simplified. Absolutely, love your videos. Allows me to truly understand my patients therapy.
This is so great to hear. I'm really happy knowing that these are helpful for you! I really appreciate the kind words and for taking the time to leave a comment.
Just graduated in May and started on a stepdown unit. Our unit just started taking dopamine gtts, but no one is used to taking it and of course I got assigned a new admit on dopamine. Your video really helped explain the function of the medication and helped me care for my patient better!
This is awesome Daniel! Glad it was a help for you and congrats on graduating and your new job!
Really enjoy your posts! I am a Paramedic with Grady and my wife is CCRN at Emory ICU and we enjoy watching and discussing your videos together. At Grady EMS We use Levo rather than Dopamine so looking forward to your videos contrasting these options. Thanks for posting.
Awesome man! I bet your arrangement makes for some interesting dinner conversations! lol
Now, when you say you use levo rather than dopamine, in what context? I'm assuming for BP as a vasopressor?
ICU Advantage Yes 👍 would appreciate hearing your thoughts and experiences. ruclips.net/video/cnAYJ8uAmPs/видео.html
We have several new people starting on my unit and I have been recommending your videos to help things click during orientation! :-)
Yay! This is so awesome. Thank you so much Tasha!
Thanks a lot !
your explanation is fantastic. thank you!
Best channel for medical knowledge
I appreciate that!
I love your videos, could you please do one on Norepinephrine and phenylephrine !
Thank you so much! Glad you like them. And yes, I do have them on the todo list! :)
Thanks for the great efforts ❤
Thank you!!! I'm doing my critical care course and your videos are making everything come together.
Great to hear this Carrie! Thats my hope is to help it click!
Thank you !
Awesome. Thank you
thanks a lot, I am now ur new follower!
Many thanks for this video👏
Thank you for explaining why an injection of metoclopramide has posibly given me dystonisa and tardive dyskinesia..
Can you guys please be extremely careful when administering dopamine drugs please?
As usual great explanation and great video thanks a lot 🌸🌸🌸
Thank you so much! I really appreciate that and happy you liked it.
Great review! Thank you.
Glad it was helpful!
Was able to understand as a new icu nurse !!
Awesome! So happy to hear this!
Thank you!
You're welcome!
Thanks Eddie
You're welcome Derek!
Good job.
Great video! Thank you
Glad you liked it!
❤❤❤
Great work sir...
Thank you so much!
Dopamine isn’t used often but it’s also not uncommon in my icu. We usually use it for heart block patients and symptomatic bradycardia but it usually gets D/Cd soon after they get TVP wires it and implanted pacer from the CCL
Agreed. TVP is the way to go for persistent symptomatic bradycardia but every now and again will see it left running if pt well responsive, as well as the occasion CTS use for renal dose 🙄
Thanks, that was Dope! hehe
Haha nice! Thank you!
Could you do a video lidocaine infusion?
On the todo list! 😊
thanks! very good
You are very welcome!
amazing content
Thank you so much!
Very helpful. 😊
Glad it was helpful!
Please explain abou doputami ...and what are the differences between dopamine and doputami
Great suggestion... perhaps stay tuned soon 😉
Thanks
Welcome
Great sir
Awesome!
❤
I love your videos!!
So happy to hear this!
Great!
Thank you!
An other great video 🔥🔥🔥
Wahoo!! Thank you!
I've read some studies (happy to find them if you'd like) that argue against the idea that Dopamine actually does have a 'renal dose,' and am curious what your thoughts are on that? It would make sense, physiologically, that it does, however there is talk amongst clinicians I've worked with in emergency/crit care who state that simply isn't the case and that mode of therapy is more old-school. Secondly, regarding its use for brady-dysrhythmias/hypotension: I've had medical directors in former EMS agencies with whom I've worked that have said its arrhythmogenic properties make it a terrible medication for use. Again, I can appreciate this as anecdotal, however at least in the pre-hospital field it's 'well-known' that Dopamine is rarely a drug we should reach for, if ever. I rarely see it in the cardiac ICU where I work currently, and when I do it is for the aforementioned renal-dose, but again I haven't noted a significant result when I've had patients on it for that reason. Would love your thoughts, and keep up the great work. your videos are awesome, thanks!
Yeah I've definitely seen the studies and the evidence seems pretty clear that renal dose is not of benefit and in fact can actually be detrimental. We do know it increases urine production. The question is, giving a dose that produces this without any added real benefit to perfusion, is that effective? The evidence seems to say no. That said, I've seen some very intelligent physicians who I trust, who still use it this way occasionally.
As for its use in ICU, I do see it a bit for bradycardia, but short of throwing the kitchen sink and then some at people, I don't often see it used for shock. That said, it is a quick access in our code carts, so sometimes it is used out of convince in shock, but usually mixing up a levo, Neo, or epi drip doesn't take that long.
I've seen it used in neonatal cases?
Good keep it up 👍
Thanks 😊
Go on 💪
Thank you!
I am a new ICU nurse and your videos have been helpful to help me understand medications that are new to me. I wanted to clarify your opinion on what my preceptor taught me. Recently, I had a patient that was in a third degree heart block that occurred on a step-down unit. Initially, the patient was given atropine with no impact and then she was placed on a dopamine gtt @ 10 mcg (she received a TVP that night). Two questions, I was told that atropine is not effective for third degree heart block. Second, do you think Dopamine IS effective for third degree heart block? The patient was in and out of the heart block until the TVP was placed; however, I wasn't convinced that the medications were the reason she converted. As I didn't hear heart block mentioned in your video, I was curious! Thanks!
Great question. Dopamine and Epi are indicated to start for CHB, but usually they won't be effective and pacing is almost always required. Sounds like your patient had a transient block of the final conduction pathway hence the going in and out.
If no p wave i was told by a ER doc that atropine wouldn’t be effective
I'm protecting 90 year old alzimer+dementia patient.short time memory is too low.tell several times can force to 10m walk,eat ...sit or stay same position.talks well. But words (vocabulary)low.Is there any memory improving drug?--- you are doing good work to the world !
Why lower dose Is 40mcg,kg,min and higher dose is 10mcg,kg,min . Can someone explain it please?
Great video thank you so much sir but some confusion you didn't talk about dopamine action on dopaminergic reseptor renal perfusion and increase urine output and also prevent cell injury.
Is Dopamine acting directly on the bete receptors or as a prodrug for norepinephrine and epinephrine.
Directly binds is my understanding.
❤
Love, love your videos. Great information. I want to know why some critical care medications are not Great to be given via peripheral IV access. Thanks for your reply
Yay! So happy to hear this. So it often depends on the medication for some of the reasons, but pressors, which are the most common that this comes up with, are due to a few things. They are vesicants and irritants and are better served infusing in to a large vessel, aka central line. Also with those we run the risk of extravasation and potentially tissue necrosis if that happens.
That said, if there is no other option, we absolutely will use peripheral IVs until we can get a central!
Should you give dopamine to heart transplant patients?
I don't have a ton of experience with this in transplant population, but from a quick search around, it seems that it is used.
Could you do a video about rhythms that almost look like sick-sinus, and the appropriate use of atropine v. dopamine?
Let me stew on these ones
@@ICUAdvantage If it helps, a lot of times this has happened with our patients who are on sedatives--often precedex, but simultaneously on esmolol and several other IV medications. I'm sure hypoxia from Covid ARDS doesn't help either. At first it caught us off guard. We thought maybe there was some vagaling, but then it started happening without inline ETT suctioning. We used atropine, got hypertensive. Then in 30 minutes or so that rhythm would come back and then eventually one of us would get annoyed with that roller coaster and just start dopamine and cardene. Usually this would resolve after the patient switched sedation. But it was always a bit exciting when we first started sedating.
😮😮😮😮😮😊
Casper de vries
S
Si verdad 😊
Casper de vries
In terms of levophed I like dopamine as a better pressor lol
Yikes! I'll take Levo any day over dopa.