Norepinephrine(Levophed) usage in ME EMS protocol
From the ME EMS Protocols : A. Preperation - Mix NOREPINephrine 8 mg in 250 ml NS. B. Dosing - Starting Dose is NOREPINephrine 0.03 μg(mcg)/kg/min. Titrate by 0.03 μg(mcg)/kg/min every 3-5 minutes. Usual dose is 0.03-0.25 μg(mcg)/kg/min. Usual max dose is 0.6 μg(mcg)/kg/min. Absolute max dose is 3 μg(mcg)/kg/min C. Titrate to maintain SBP greater than 90 mm Hg. For 2013 the Medical Direction and Practice Board decided to move away from Dopamine to Norepinephrine. I am no doctor (yet) but I'm guessing it has to do with some of these studies ( 2 , 3 ). A subgroup analysis showed that dopamine, as compared with norepinephrine, was associated with an increased rate of death at 28 days among the 280 patients with cardiogenic shock but not among the 1044 patients with septic shock or the 263 with hypovolemic shock - Daniel De Backer, M.D., Ph.D., Patrick Biston, M.D., Jacques Devriendt, M.D.... for...