This video shows how to setup and use a norepinephrine drip. A few corrections for misspoken terms in the video: yes, it is an ampule, not a vial; norepinephrine comes 4mg/4ml, not 4mg/ml.
If we do have to go to a 250ml bag (in future shortages) would it be acceptable to load 1mg into the bag making the drip rate on the page still accurate?
When treating a hypotensive respiratory patient who is fluid overload, whether it be flash pulmonary edema or just extreme CHF, can we jump on levophed faster, so we don't have to worry about a fluid challenge making the overload worse?
Still want to start with fluid, but more cautiously. You want to give small aliquots, slowly and watch for changes. I would give 100ml bolus and see if it improves the blood pressure. I would probably give at least 2 of these boluses before adding norepinephrine. We need to remember, norepinephrine will fix the blood pressure and make us feel better as careproviders because the BP is improved, but it is not necessarily great for the patient. That's why you want to try fluid before jumping straight to norepinephrine. And if you get the sbp >90, I would probably leave the norepinephrine alone unless the patient starts dropping again.
Carly, I was able to see you're other question asking "Is this not weight-based, does everyone start at 4mcg/minute?" The answer is yes, we have created a dilution that is not weight-based and you can start at 4mcg/minute. And remember, you can actually start at 2mcg/minute as well - you would just drip at 1 drop/ 2 seconds or 30 drops/minute. We created the dosing chart because it simplifies the math.
