Milrinone Simplified — ICU-Level Crash Course for Real Clinicians

Timestamp Topic Title
[00:00] Introduction: Milrinone as a Powerful Inodilator
[00:17] Classification: Phosphodiesterase 3 (PDE3) Inhibitor
[00:44] Mechanism of Action: Inhibits PDE3 to Increase cAMP
[01:25] Cellular Effects: More Calcium for Contraction (Inotropy) and Less Calcium for Vessel Tone (Vasodilation)
[01:48] Hemodynamics: Increases Contractility/Cardiac Output, Decreases Preload/Afterload
[02:08] Indications: Acute Decompensated Heart Failure (Preferred over Dobutamine in Beta-Blocked Patients)
[02:35] Other Indications: Cardiogenic Shock, Post-Cardiac Surgery, RV Failure, Bridge to Transplant
[02:48] Contraindications: Severe Hypotension, Fixed Outflow Obstructions, Renal Impairment (Dose Adjust)
[03:15] Pharmacokinetics: Half-Life of 2-3 Hours (Relatively Slow Offset)
[03:50] Clinical Implication of Slow Offset (Less Titratable than Catecholamines)
[04:15] Importance of Loading Dose (Prevents 8–18 hours to reach Steady State)
[04:39] Discontinuation Effects (Requires Careful, Gradual Taper)
[04:58] Key Advantage: Beta-Receptor Independent
[05:15] Summary: Milrinone's Role in Decompensated Heart Failure

If you’re at the bedside managing a crashing patient on inotropes, this is your quick and dirty guide to Milrinone — the ICU’s go-to inodilator. In this crash course, we break down exactly how Milrinone works, when to use it, and what to watch for in real-time hemodynamic management.
Learn how this phosphodiesterase-3 inhibitor boosts cardiac contractility, reduces afterload, and improves forward flow — all without overwhelming the heart. We’ll connect mechanism to monitor, so you understand how those changes in cardiac output, SVR, and MAP translate to what you see on your screen.
Perfect for critical care nurses, residents, and intensivists, this is the no-fluff, high-yield explanation you can actually use at the bedside.

This is Pulse and Pressors — providing a daily education on the marvels of the human body.
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