I am excited! I completed the CCRN Academy review & passed. I enjoy ICU Advantage and really excited for you to share this with us! Can't wait to get started!
@@paigeaspinwall5835 Way to go Paige!! Excited to officially open things up and be able to provide CEs for all this education. As always, thank you so much for all your support! Really glad to know you will be a part of this and are excited for it.
I once had a patient on this. On 0.4 mcg/kg/min, he was snowed. But on 0.3 he was wide awake and agitated. Such a strange medication. Either works wonderfully or is just frustrating, in practice. Great video!
We have a frequent return LVAD patient who loves the recreational drugs outside the hospital. She's wild and awake maxed on fentanyl and prop, but add a bit of dex and she's comatose. So weird.
I just completed a study with Yale research unit. As a fentanyl addict, Dexmedetomidine along with low tapering doses of methadone got me through a 7 day withdrawal period. Now that I’m home, symptoms are weak enough to deal with using ibuprofen and CBD. Excited to see where this drug takes us in the OUD crisis
Is it possible to be allergic to this medication ?and if so what would be the physical attributes to look for in a patient with a (stage 3 TBI DAI , under went a craniotomy and cranioplasty and also has a shunt . Patient has awaken but unable to speak due to trach . )
There is a very odd and specific cohort of patients for whom this medication works reasonably well for. Just from experience and observation, 9/10 this med doesn't do diddly squat.
Dexdor! (Here in Italy it's the brand name) When I began working in cardio ICU coming from a big ward full of patients with delirium this drug was a MIRACLE to me... No more running after granny who's ripping off her CVC/catheter, you name it...while another one tries to ace the diving championship jumping head first from the bed and another two gramps are escaping 😂 The most frequent side effect we observe is bradycardia, followed by hypotension. We use it in agitated patients whose devices do not have to be tampered with (e.g. Swan Ganz, arterial lines, or if they need a CPAP helmet but tear it off). Or in case of small procedures. As you say, the dosing and rate is decided by the facility. We have a protocol in place. Thank you, clear and concise as always 🔝
Haha oh the stories we come across in healthcare! People have NO idea! Thanks so much for sharing Bianca. I've had mixed success with it, but have found at facilities that allow for larger doses, that it can be more effective. Sometimes, some people just don't respond. Agreed that Brady and hypotension are the most common and often the biggest reason to stop using it.
Yeah definitely helpful in the ED as well. Some topics may not apply, but most do. As for the Academy (I’m assuming that’s the membership you’re referring to) that basically has all the benefits of all RU-vid/Patreon membership tiers, plus, most importantly, you’ll be able to get CEs for watching these video lessons I put together.
Thank you so much for the videos on the different drugs. Just started to work with Milrinon and Dex. as soon as your videos came out. Perfect timing. Highly appreciate it!
Can precedex drop blood pressure less common than it does heart rate? The NP I worked with tried to tell me it doesn’t affect blood pressure, even though this patient is sensitive to sedation already.
Another great video! Precedex is a fantastic med when it works, we use it often on our post op CABG patient until we can extubate or even with low tolerance to bipap because it’s very useful for anxious intubated patients most of the time and doesn’t have too much of a effect on our hemodynamics most of the time. Although some patients have a really good tolerance to it and require more sedation/pain relief.
Whole heartedly agree! When it works, it works magic. And that fact that it doesn't cause respiratory depression makes it possible to use in so many situations we wouldn't normally be able to. Thanks so much for your support!
3:46 don’t benzos and propofol activate, rather than inhibit GABA receptors? GABA agonists sedate. 4:53 isn’t the hypotension from the activation of alpha 2 receptors on peripheral vasculature like colonidine
So for the GABA section I definite said that weird. Basically what I was trying to state is that the impacted neurons would be inhibited. Which yes the activation and potentiation of GABA receptors increases inhibitory effects of GABA. As for the hypotensive/bradycardic effects of both Dex and Clonidine, it seems to be that both work in brain stem by inhibiting norepi release at neuronal junction preventing activation of sympathetic response thus vasoconstriction and bradycardia can result.
@@ICUAdvantage gotcha. I think the bradycardia is from norepinephrine inhibition to the vagus nerve, and alpha 2 agonism is from activation at peripheral vasculature (activating alpha 2 receptors vasodilators arteries.) Double checked and the second part is what I’m getting on UpToDate, the 1st part about the vagus nerve from an attending about why precedex causes bradycardia but clonidine causes tachycardia (no baroreceptor reflex with precedex like with clonidine)
@@nygeek6471 Interesting you mention about the vagus nerve. Looking around now specifically for that I do so a couple things talking about increasing vagal activity via Ach, but still most seem to point to the central inhibition of sympathetic activation as the primary driver of Brady/hypotension with a2 agonists. That is an interesting point about the reflexive tachycardia and I'll have to look into it more as to why we wouldn't still have potential for baroreceptor reflex with Dex.
@@ICUAdvantage thanks! Love the pharm/patho. P.s. ach is the parasympathetic signaling pathway in the CNS, it cascades from GABA like norepi cascades from glutamate. This is why anticholnerigcs increase heart rate via inhibiting the vagus nerve (and heart transplant patients don’t have vagal innervation hence why atropine won’t work in them)
My preceptor and myself (I am new to practice nurse this past December) got floated from ICU stepdown to ICU and we had a pt on this drip while alert on HFNC. It kept them calm so they would put their O2 demand up. It went well. Thank you as always for teaching this stuff. I am hoping in some time to move from stepdown to ICU.
It’s very hit or miss. It’s also prone to nasty hemodynamic effects. It can also decrease RBC count. Definitely not to be used outside of an ICU setting
Agreed with others. Very love hate relationship. When it works, its great and perfect for what is needed. Other times, no matter how high you go, it seems to be no better than saline. Glad to hear it helped in your situation and hope to hear from you again when you get into the ICU!
@@ICUAdvantage totally agree with the sometimes it feels like it’s just saline, other times it works. Sometimes your patients hemoglobin is dropping when they’re on it for too long. Other times they go into arrhythmias. Overall I’m not a fan of precedex at high doses for long periods of time. I feel like I can get more from low dose prop with less side effects
Eddie can you PLEASE make a series for Med Surg nurses wanting to transition to critical care? There's such a learning curve and barely any of it was covered in school. If you make it and choose to put it behind a reasonably priced pay wall, I'll pay!
Hey there! So I do have plans eventually to do like an ICU Bootcamp type of course, but honestly with my time commitments right now, probably won't be any time soon for that.
@ICUAdvantage ofc I get that sir. ill be on the lookout when you do drop if I haven't transitioned by then. meanwhile do you have any other creators you recommend on RU-vid to help with that?
@@ICUAdvantage as far as I remember its 2000mcg at 250 glucose, we call it the BIG dexdor infusor^^ but honestly it works pretty well and we need less volume over the day which is benefitial to the patients in most cases.
GABA receptors are involved as a binding site for ethanol. In the same ways that benzos bind to GABA receptors to produce inhibitory action, Dex also influences the inhibition of GABA neurons, helping to prevent withdrawal symptoms and DTs. That along with the sedation without respiratory depression can be helpful in managing severe alcohol withdrawal that normally has required over sedation with benzos, and thus a prolonged ICU stay.
@@08MordSith Correct about not hitting GABA. It effects upstream with same inhibition of GABA neurons without direct binding like beznos and prop. My experience tho has been with it as an adjunct with typical benzo treatment. Helps prevent high dose benzo drips and can help with reduced dosing of Bezos based on CIWA.
Agreed! We typically would just use analgesics in recovery when possible, but if some sedation or anxiety control was needed, this was typically our goto.
I have found that this drug always works. I’ve been using it for years on my patients in the ICU and has been a life savor for my patients and my sanity. I can’t think of a time where it has totally failed me. ❤️ Precedex… thanks for informative video.
Thank you very much😭 I just started working in Cardiac Care ICU looking after patients post MVR, CABG. My patient was on this drip together with Noreadrenaline, Dobutamine and Propofol. Thank you your videos are indeed very helpful. It lessens my anxiety and boosts my confidence. God bless you!💜💜💜
Hey Rez! Thanks so much for taking the time to drop a comment. ❤ Really glad to hear the videos are helpful for you and help to take the edge off. I know it can be stressful at times so truly happy to know they are helping you out.
@@ICUAdvantage im picking up extra shifts and saving up so I can purchase ICU advantage Academy. I want to take this skill in a new level. My goal is to be CCRN certified. 🙏🏻✨
