drip rate
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rescuecpt
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I have to look at my notes at home, there are a couple tricks - mostly memorizing a certain scenario (around here we only drip dopamine usually at 5mcg/kg) and different weights/rates for that scenario.
ResTech
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My opion is that more ALS providers should use a calculator to figure out dosages just for accuracy and verification the same as most in-hospital practitioners. For fluid alone, not much to calculate. It's either "wide-open" or KVO which is usually about 30cc/hr which equals 8gtts/min which is easy to memorize. But again, KVO doesn't even have to be that specific and never do you get an order for an IV of NSS at 100cc/hr. But there is an easy way to figure out IV drip rates based on time and your drip set.
This .pdf file will be the most valuable download ever and explains drips well. Drug Calucations for Busy Paramedics - http://gaems.net/download/drugcalc.pdf.
And as far as medication drips, you got lidocaine and dopamine.
Lidocaine just use the clock and dopamine, well you have to memorize the formula or carry an ALS pocket guide with you that has a chart in it.
Sorry, would write more but girlfriend is yelling for me to come in and watch a movie. Later.
This .pdf file will be the most valuable download ever and explains drips well. Drug Calucations for Busy Paramedics - http://gaems.net/download/drugcalc.pdf.
And as far as medication drips, you got lidocaine and dopamine.
Lidocaine just use the clock and dopamine, well you have to memorize the formula or carry an ALS pocket guide with you that has a chart in it.
Sorry, would write more but girlfriend is yelling for me to come in and watch a movie. Later.
croaker260
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first thing to learn, with a 60 gtt set, 1 gtt a min = 1 cc/hour and 60gtt to a cc.
Its nice that many of your drips are not actually that hard.. You just got to quize your self....learning them is no different than learning the rest of your drug doseages. Every one is a little different, with different tricks. Find out what works for you.
For example, Lidocaine, Procainamide, and Brytillium (when we used to carry it) for maintanence are the same. Some people learn a "clock" to visualize it, I do it the old fasioned way. Both work.
1 gm in 250 = 4 mg/1 cc concentration,
15 gtt a min = 1 cc a min = 1 mg a min.
Depending on drug you run start at 15 or 30 gtt/min (1-2 mg/min) and titrate as appropriate based on the drug.
Epi drip for refractory bradycardia is very similar, 1 mg (not GM) in 250...gives you a 4 mcg/ml concentration instead of a 4 mg/ml concentration...but the principle still applies...
15 gtt a min = 1 cc a min = 1 mcg a min
since you run epi at 2-10 mcg a min, you start out at 60 gtt a min (1 gtt/sec) or 1 gtt every "mississippi"
Dopamine, dobutamine are a little different because they are weight based, but there are "clock" visualizations for that too. I am luck, I have it on the wall, in my PDA, and can figure it out with a pen as needed...which is fortunately seldome. Many pumps (like the mini med III) will figure it out for you. Just be sure you weight is accurate.
Its nice that many of your drips are not actually that hard.. You just got to quize your self....learning them is no different than learning the rest of your drug doseages. Every one is a little different, with different tricks. Find out what works for you.
For example, Lidocaine, Procainamide, and Brytillium (when we used to carry it) for maintanence are the same. Some people learn a "clock" to visualize it, I do it the old fasioned way. Both work.
1 gm in 250 = 4 mg/1 cc concentration,
15 gtt a min = 1 cc a min = 1 mg a min.
Depending on drug you run start at 15 or 30 gtt/min (1-2 mg/min) and titrate as appropriate based on the drug.
Epi drip for refractory bradycardia is very similar, 1 mg (not GM) in 250...gives you a 4 mcg/ml concentration instead of a 4 mg/ml concentration...but the principle still applies...
15 gtt a min = 1 cc a min = 1 mcg a min
since you run epi at 2-10 mcg a min, you start out at 60 gtt a min (1 gtt/sec) or 1 gtt every "mississippi"
Dopamine, dobutamine are a little different because they are weight based, but there are "clock" visualizations for that too. I am luck, I have it on the wall, in my PDA, and can figure it out with a pen as needed...which is fortunately seldome. Many pumps (like the mini med III) will figure it out for you. Just be sure you weight is accurate.
There are some shortcuts out there for some drugs. It depends SIGNIFICANTLY upon what concentrations you carry in your county.
For Dopamine, for example, I've worked up the following shortcut that gets you nearly the exact correct dose (to be specific, it overdoses by 6.7%, which I consider to be pretty minor consider the inaccuracy of calculating the exact number of drops per second, and if you follow the process, will still keep you in the correct dosing range).
In our county, we carry Dopamine as a 400mg in 250cc concentration. We use a 60 gtt drip chamber for Dopamine. Our protocol specifies one dosage for Dopamine, which is "5-10 mcg/kg/min". Using those fixed figures to eliminate the variables in the drug calcs, here is the shortcut...
"Start with # of drips per 30 seconds = 10% of patients body weight in kg. Titrate up to "just under" double that figure." That's it!
If you do the formula, a 400mg in 250cc concentration at our starting dose of 5mcg/kg/min for a 100kg person is 18.8 drops per minute. That should go up to 10mcg/kg/min, which is 37.5 drops per minute. So in 30 seconds, those are 9.4 and 18.8 drops per second.
The shortcut calculation for 100kg person is "start with 10 drops in 30 seconds, titrate up to just under 20 drops in 30 seconds". So 10 vs. 9.4, and "just under 20" vs 18.8. Given the margin of error in drops in a bouncing ambulance, that is pretty good, takes 2 seconds to calculate, which is even faster than finding your reference materials, and is more accurate that visualization of a 'drug wheel' shortcut.
Of course, this is my personal calculation (maybe others have come up with it as well, I have no idea), so don't use it or anything I say without verifying everything yourself, adjusting for your county, and checking with your provider.
For Dopamine, for example, I've worked up the following shortcut that gets you nearly the exact correct dose (to be specific, it overdoses by 6.7%, which I consider to be pretty minor consider the inaccuracy of calculating the exact number of drops per second, and if you follow the process, will still keep you in the correct dosing range).
In our county, we carry Dopamine as a 400mg in 250cc concentration. We use a 60 gtt drip chamber for Dopamine. Our protocol specifies one dosage for Dopamine, which is "5-10 mcg/kg/min". Using those fixed figures to eliminate the variables in the drug calcs, here is the shortcut...
"Start with # of drips per 30 seconds = 10% of patients body weight in kg. Titrate up to "just under" double that figure." That's it!
If you do the formula, a 400mg in 250cc concentration at our starting dose of 5mcg/kg/min for a 100kg person is 18.8 drops per minute. That should go up to 10mcg/kg/min, which is 37.5 drops per minute. So in 30 seconds, those are 9.4 and 18.8 drops per second.
The shortcut calculation for 100kg person is "start with 10 drops in 30 seconds, titrate up to just under 20 drops in 30 seconds". So 10 vs. 9.4, and "just under 20" vs 18.8. Given the margin of error in drops in a bouncing ambulance, that is pretty good, takes 2 seconds to calculate, which is even faster than finding your reference materials, and is more accurate that visualization of a 'drug wheel' shortcut.
Of course, this is my personal calculation (maybe others have come up with it as well, I have no idea), so don't use it or anything I say without verifying everything yourself, adjusting for your county, and checking with your provider.
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Welcome to the group, and I hope that you continue to post good information like that.
rescuecpt
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Thank you...i found that this file was very helpful.
I'm doing my EMTCC course and the math part is killing me. Soo i will take whatever help anyone can give me.. gaems.net/download/drugcalc.pdf [/b][/quote]For the NY exam there are really only a few rates you need to know - they'll only ask about a 5mcg dopamine drip, and you really only need to memorize the weights in pounds/kilos that will get you to a 15, 30, or 45 drip rate, since they almost always (as in I've never heard of it before but there's always an off chance) ask one of those three.
Now, as far as real life, you need to know the rest, but for exam purposes, this will get you through.
Originally posted by rescuecpt@Apr 14 2005, 09:04 AM
Thank you.... Since November, everyone keeps telling me that i will know the math by the time the class is over in June, yeah right i don't see that happening..
akflightmedic
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I started to read the dopamine shortcut and it just seemed too complicated.
I will now give you 3 am math for a dopamine drip and the error margin is just as the other posted, it is so insignificant.
Work out the problem yourself and you will find it to be amazingly close to the correct dose.
Take the pt's weight in pounds, drop the last number and that is how many drops a minute you need to give to achieve 5-6mcg/kg/min.
Example: Pt weighs 198 pounds, drop the 8 and start the infusion at 19 drops a minute.
I will now give you 3 am math for a dopamine drip and the error margin is just as the other posted, it is so insignificant.
Work out the problem yourself and you will find it to be amazingly close to the correct dose.
Take the pt's weight in pounds, drop the last number and that is how many drops a minute you need to give to achieve 5-6mcg/kg/min.
Example: Pt weighs 198 pounds, drop the 8 and start the infusion at 19 drops a minute.