Methylene blue and hydroxocobalamin are rescue therapies sometimes considered for vasoplegic shock and refractory vasodilation. In this episode, we compare methylene blue with hydroxocobalamin, focusing on mechanisms of action, nitric oxide-mediated vasodilation, hemodynamic effects, dosing considerations, adverse effects, and practical clinical use. Topics covered include: • What vasoplegic shock is • Refractory vasodilation and shock physiology • Nitric oxide-mediated vasodilation • Methylene blue mechanism of action • Hydroxocobalamin mechanism of action • Hemodynamic effects of methylene blue • Hemodynamic effects of hydroxocobalamin • Clinical scenarios where these agents may be considered • Dosing and administration considerations • Adverse effects and monitoring • Interference with labs, pulse oximetry, and dialysis machines • Methylene blue versus hydroxocobalamin comparison • Practical bedside considerations in vasoplegic shock Watch the full video on YouTube: https://www.youtube.com/watch?v=LfBMevNxEfg 📚 Want More Emergency & Critical Care Medicine Education? Join the WhiteBoard Medicine Patreon community: https://www.patreon.com/WhiteBoardMedicine Patreon members receive access to: • Downloadable Study Guides • Clinical One-Pagers • Practice Questions • Mini-Courses • Comprehensive Clinical Reviews • Ad-Free Videos • Early Access Content 🌐 WhiteBoard Medicine Website Explore our growing library of critical care and emergency medicine content: https://www.whiteboardmedicine.com ⚠️ Educational Disclaimer: This content is intended for educational purposes only and should not be used as a substitute for clinical judgment, institutional protocols, specialist consultation, or individualized patient care. Full disclaimer: https://whiteboardmedicine.com/disclaimer

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“What did the council decide on item 42?” — answered with the speaker and the moment.

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