# dopamine question



## daedalus (Jun 26, 2009)

This is a pretty dumb question, when calculating the gtts/min rate for a dopamine infusion, are you assuming you are using 10gtt tubing?

Our program director allows us to use the formula:
mcg x kg x 0.37 = gtts/min

IIf anyone else is using this formula, could you enlighten me as to what the hell sized tubing they are assuming you are using? Because 10 gtts a minute on micro tubings is a hell of a lot different in 10 gtts/min on a macro tube.


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## PapaBear434 (Jun 26, 2009)

It's funny, because when I am in class they tell us to just go ahead and assume 60 gtts unless specified otherwise.  In the field, though, I don't think I've used anything but a 10 gtts set, or even seen one used.  We have them available, but they just sit there.  

Best advice is to ask HIM what to assume the drip set is.  Assume wrong, and your numbers are going to be WAY off.


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## Ridryder911 (Jun 26, 2009)

daedalus said:


> This is a pretty dumb question, when calculating the gtts/min rate for a dopamine infusion, are you assuming you are using 10gtt tubing?
> 
> Our program director allows us to use the formula:
> mcg x kg x 0.37 = gtts/min
> ...



You should *NEVER* use anything but a micro drip (60 gtts/ml) set! Using a macro or solution set is inaccurate (unless using a IV pump) as the drip can be large, small hence: the reason for the pipette. 

R/r 911


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## DrankTheKoolaid (Jun 26, 2009)

*re*

regardless of drip tubing size this equation works for them all.  But obviously you should be using a dial-a-flow with micro tubing.

pt. wt x mcg/kg/min x tubing size
____________________________

1600

assuming you are using 400mg/250cc standard concentration.  if not adjust accordingly.


If he wont allow you to use this equation when doing your calculation's.  you can at least use it to double check your own equations


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## daedalus (Jun 26, 2009)

Corky said:


> regardless of drip tubing size this equation works for them all.  But obviously you should be using a dial-a-flow with micro tubing.
> 
> pt. wt x mcg/kg/min x tubing size
> ____________________________
> ...


Rid, corky, thanks.

Well, I can use your equation because our tests are mainly multiple choice and therefore the result of your equation will be pretty close to one of the answers.

I appreciate all the responses.


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## PapaBear434 (Jun 26, 2009)

daedalus said:


> Rid, corky, thanks.



Oh, I see how it is.  My answer of "Go ask your instructor" was too simplistic for you.  Fine, be that way.  I didn't want to help anywho!

Not that I helped, anyway.  But still.  I tried.  Kinda.  

/skulks off


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## daedalus (Jun 26, 2009)

PapaBear434 said:


> Oh, I see how it is.  My answer of "Go ask your instructor" was too simplistic for you.  Fine, be that way.  I didn't want to help anywho!
> 
> Not that I helped, anyway.  But still.  I tried.  Kinda.
> 
> /skulks off


Thank you PapaBear!!!


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## TransportJockey (Jun 26, 2009)

If you ever tried to run dopamine or lido with something other than 60 drop sets or pump tubing (for the services that carry pumps in the field, which is both private services here in ABQ), the docs would have every right to bite your head off


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## ResTech (Jun 27, 2009)

Amen to the 60 dropper only set for IV drips... although if you didn't have a 60 dropper for some reason you could still administer the proper flow rate with a macro drip if need be. 

We use 20gtts sets as the standard.... since that is what the ED uses and we restock from there. I like this formula:

dose(mcg) x weight(kg) x drip set (60)
                     1600mcg

It's easy to remember... our Dopamine is the standard pre-mix of 400 in 250mL to get the 1600mcg concentration so it works out even better. Even if it didn't its not hard to figure out the concentration by dividng the drug into the volume of fluid in the IV bag.  

Our instructors are good about the calculations and realize that they're is more then one correct way to get the right answer and as long as its right... they don't care what method you use.


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## rhan101277 (Jun 28, 2009)

I know this may be a stupid question, but what if the patient is alone and unresponsive, how do you go about your weight measure for your drug calculations?


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## daedalus (Jun 28, 2009)

rhan101277 said:


> I know this may be a stupid question, but what if the patient is alone and unresponsive, how do you go about your weight measure for your drug calculations?


It is quite simply a guess. If you are underestimating, you will titrate up.


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## ResTech (Jun 29, 2009)

As Daedalus said.... you just have to estimate... that's the only way when the pt. or family cannot tell you. Or as my one instructor would like to say... take a SWAG... a scientific wild *** guess...


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## rhan101277 (Nov 1, 2009)

I was discussing dopamine infusion with a RN at clinicals yesterday and she said it must always be ran on a infusion pump.  She said she would write up any medic that came in with dopamine hanging (again I am talking infusion)  When I told her our service doesn't have infusion pumps, she said that usually the pump would go with the patient if it was a transport, I have never seen this.


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## daedalus (Nov 1, 2009)

rhan101277 said:


> I was discussing dopamine infusion with a RN at clinicals yesterday and she said it must always be ran on a infusion pump.  She said she would write up any medic that came in with dopamine hanging (again I am talking infusion)  When I told her our service doesn't have infusion pumps, she said that usually the pump would go with the patient if it was a transport, I have never seen this.



Wow, she clearly has no idea what she is talking about. It may be a hospital policy to place all pressors on pumps as a added safety precaution, but we mostly do not carry pumps in the field. How can an RN even write up a paramedic (unless it is a hospital based service??). It would not get very far if your local medical director has protocols for field dopamine infusion. 

Just ignore her.


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## VentMedic (Nov 1, 2009)

daedalus said:


> Wow, she clearly has no idea what she is talking about. It may be a hospital policy to place all pressors on pumps as a added safety precaution, but we mostly do not carry pumps in the field. How can an RN even write up a paramedic (unless it is a hospital based service??). It would not get very far if your local medical director has protocols for field dopamine infusion.
> 
> Just ignore her.


 
If it is an IFT transport, you bet she can write it up and that could cost that company its contract if it also has other patient safety issues. 

The only time we allow certain medicated IVs to leave the hospital on transport is during a hurricane evacuation where we may use the dial-a-flows. 

For field EMS, there are now many services that do require at least a dial-a-flow and some do require an infusion pump for certain drips. 

Thus, unless you know that EMS agency's protocols, you can not say that RN is wrong.


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## daedalus (Nov 1, 2009)

VentMedic said:


> If it is an IFT transport, you bet she can write it up and that could cost that company its contract if it also has other patient safety issues.
> 
> The only time we allow certain medicated IVs to leave the hospital on transport is during a hurricane evacuation where we may use the dial-a-flows.
> 
> ...



Hence why I said hospital based service..

It is my impression that somebody told him that he cannot start a dopamine infusion _in the field_ without a pump, which is wrong. If his service does not carry pumps and it is in his scope of practice and local protocol to start them in the field, you bet he can still start one (with orders or under protocol) without a pump when it is indicated. 

IFT is another story. In that case, the dopamine should def. be on a pump. Of course as you know, in california that would be an RN would have to accompany the patient if on a dopamine infusion.


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## VentMedic (Nov 1, 2009)

daedalus said:


> It is my impression that somebody told him that he cannot start a dopamine infusion _in the field_ without a pump, which is wrong. If his service does not carry pumps and it is in his scope of practice and local protocol to start them in the field, you bet he can still start one (with orders or under protocol) without a pump when it is indicated.


 
But you don't know what the protocols are for the EMS services in that area as it was not stated.  Even some of the FDs carry infusion pumps for certain drips and they are held to using them.   Dial-a-flows are also popular but they are not meant for use with all medications that need to be timed with accuracy.     

Hopefully the OP will come back with the protocols for that area.


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