Dopamine calculations

[Hubbie]

I just joined a few minutes ago, so I am unsure if someone else has posted this. But I am looking for a quick and simple way of doing dopamine calculations on the fly. I know of the clock method, but does anyone else know of another method?

Hubbie

 

[Ridryder911]

Ironically, I taught a refresher today and tested over Dopamine gtts, making each actually not to use "short cuts", cheat cards, and even calculators. It is part of the responsbility of the health care proffesional on knowing how to actually perform math for pharmacology.

After, one has mastered and that there is the short cut methods if the dosage is within the range. The clock method, the other method is the The Colorado Down and Dirty Dopamine Dose Ditty" Take the weight in pounds /10 then substract 2. This gives you pump in ml/hf or gtt/min for Dopamine @ 5mvg/min (with a concentration @ 1600 mcg/ml).


The other is 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.

R/r 911

 

[Hubbie]

Thank you, that helped me a lot.

Hubbie

 

[eggshen]

I knew the guy that came up with the Colorado dose thing. At least he thought so. Pt. wt in pounds, drop the last number, take the remaining number and subtract one. That is your dose for 5ug/kg/min @ concentration of 1600. Works everytime. Not that we ever give dope or not that you gave administer it accuratley in the back of a moving bus w/o a pump. In fact I think we should get rid of it.


Egg

 

[Ridryder911]

I knew the guy that came up with the Colorado dose thing. At least he thought so. Pt. wt in pounds, drop the last number, take the remaining number and subtract one. That is your dose for 5ug/kg/min @ concentration of 1600. Works everytime. Not that we ever give dope or not that you gave administer it accuratley in the back of a moving bus w/o a pump. In fact I think we should get rid of it.

Egg

The Colorado dosage calculation has been around for several decades, and is taught in Bledsoe's CCP book, per renown cardiology instructor Bob Page.

I am inquiring how you treat cardiogenic shock, if you don't use Dopamine or how you treat Septic shock as well, since this the most common and safest vasopressors. Fluids are contraindicated. One can use a micro-or mini drip and administer it fairly accurate; although I do agree a pump is better, hence why we carry pumps on our EMS units (not a bus, that is what people ride to and from work and school ).

Just because a specific EMS service is not able to provide the equipment or train to be able to provide that care does not mean the patient should be able to be treated accordingly.

R/r 911

 

[eggshen]

We run about 80,000 calls a year here. If I remember correctly we use Dopamine 4-6 times a month across the entire service. I cannot recall the percantage but a fair amount of those are given outside of protocol. Simple things like not making base contact prior to administration all the way up to improper dose and indication. Without getting into the training issue I don't think it is given enough correctly enough to warrant keeping it on the car. It seems as though the risk out weighs the benefit of keeping it around. When our transport times for sick patients rarely exeed 7-10 minutes my thought is I would rather remove the risk. Granted, when given correctly (dose and indication) it is a great drug, we just don't see enough indication to give it. The last time I had a pt. that needed it and had time to mix it up was at least 9yrs ago. This is seeing 7-10 pts per 10hr shift.

Egg

 

[Ridryder911]

We run about 80,000 calls a year here. If I remember correctly we use Dopamine 4-6 times a month across the entire service. I cannot recall the percantage but a fair amount of those are given outside of protocol. Simple things like not making base contact prior to administration all the way up to improper dose and indication. Without getting into the training issue I don't think it is given enough correctly enough to warrant keeping it on the car. It seems as though the risk out weighs the benefit of keeping it around. When our transport times for sick patients rarely exeed 7-10 minutes my thought is I would rather remove the risk. Granted, when given correctly (dose and indication) it is a great drug, we just don't see enough indication to give it. The last time I had a pt. that needed it and had time to mix it up was at least 9yrs ago. This is seeing 7-10 pts per 10hr shift.

Egg

That is quite a bit of use of Dopamine. My service only runs a quarter of that number and we administer it at least weekly. Seriously, you have not seen a hypotensive (non-traumatic) patient in 9 years?

Now, I understand your point, but making excuses of poorly trained medics that are not being able to administer it does not make a good point to remove vasopressors. How often do you see Lidocaine drips, defibrillations occur or even crich's.. chest decompressions being performed ?... Would you remove those procedures and/or medications?

Personally for myself, I would not want nor to have my patients to have a pressure of 60/40 or lower for 7-10 minute transport time or more. (realistically we are looking at the least of 30 minutes, due to scene time, ER time, etc.) .. remember coronary circulation is now being impaired as well as kidneys, etc.. I am sure those four patients a month would much prefer to keep their coronary circulation as well, why would a Paramedic level need to call in for routine cardiac medications?

Personally, I have not seen Dopamine not used in a "pre-mixed" solution in about 10 years... why not have that? It is much easier and less dangerous.

Again, another typical situation in EMS, let's correct the problem not remove the solution.

R/r911

 

[eggshen]

I and a grand majority of my co-workers do very little on scene. Nearly everything is done enroute. I have seen plenty of hypotensive patients, I just tend to move fast and am left with little time. I can't remember a time I thought to myself hmmmm that guy would be better off in an ambulance instead of the ED. I do what I have time to do and get the next one.

As far as pre mix? Yea, used to carry it but bean counters tend to go for lowest bidder when it comes to product. What the hospital uses, we use. Whether or not it is good for street use is never taken into consideration.

Why not address the morons that cannot do their job? Again adminitration, I can't remember the last time anyone got gigged for messing up on a call. Our medical director has an agenda known only to him. Good guy but it would be nice so see someone get a few days on the beach for buggering a call

Egg

 

[Ridryder911]

Sorry, your exposure and service appears to be very lacking. There should be no difference in pre-hospital care and in the ER for non-trauma induced hypotension.

Why have EMS, when all you do is load and go? One might as well, just have ambulance drivers with basic first aid that can drive real fast.. be a lot cheaper, and would not confuse the public that they are going to get medical care.

I understand, nothing is going to change until your medical director seems necessary.

R/r 911

 

[triemal04]

The best way I know is to multiply the amount you want to give by the weight in kilograms, then divide that by 25. This will give you ml/hr, which, if you're using a microset (60gtt/min) is the same as drops/min.

So it'd be (5-20 x wt)/25=gtt/min OR ml/hr. This isn't 100% accurate, something more like 95%, but, if you're using a dripset it's not going to be 100% accurate anyway. Keep in mind that this will only work for the standard concentration dopamine, 1600mcg/ml, so if you mix your own, then it won't work.

If you don't have a microdrip it can still work. Work out the formula, then divide your answer by 6 if you have a 10set, or 4 if you have a 15set. This will give you drops/min. Still not 100% accurate, but pretty damn close.

 

[eggshen]

My exposure has been nothing short of prolonged and dramatic.

My agency (save the aberrent few) has been one of the premier agencies in the country for a long time. Having said abbreviation on your resume is historically a very good way to get a job.

At the end of the day our job is to transport to definitive care and stabilize enroute. If I wanted prolonged exposure to patients I would work for a hillbilly hodunk pondunk well then there rural agency (I don't have enough stuff for my belt) or go to medical school. No, I like ditch medicine and moving fast (we have some of the best pre-hospital penetrating trauma save rates in the country due to just that). If I am presented with a protracted tranport time i.e., intl airport into the city (15min), sure, I can hang with anyone.

When it is all said and done however we are ambulance drivers. I would love nothing more than to educate the public and everyone else about the difference but I don't see happening it in my lifetime. Untill then I will do what I can between A & B and accept that it is what it is ,a vocation, not a profession.

I don't know where you work but in my town no one expects medical care, it's "are you taking me to the effing hospital or not!". Unless, of course, you are in the 'hood and no one seems to think you are helping nana or the homeboy with the very non-acute problem quick enough. My pt. care population is confused enough.

Driving fast does not help, seconds never, ever count.

Egg

 

[Hubbie]

I work for a very progressive practice and we do carry dopamine. I have only had to give it once, but I would rather be well versed in its use than lack in it so that next time I have to give it I will not be delaying pt treatment by having to look up how to do the calculations. We do not have pumps on our units, but we do have dial-a-flows, and while not as accurate as a pump it gets the job done, and it is certantly easier than trying to count the drops in a 60 gtts set.

One of my co-workers, who is also a CCP, told me a method of figuring out the drip rate, but all I got out of it was a major headache. I suppose different methods for several people.

Once again, thats for the advice.

Hubbie

 

[Ridryder911]

I work for a very progressive practice and we do carry dopamine. I have only had to give it once, but I would rather be well versed in its use than lack in it so that next time I have to give it I will not be delaying pt treatment by having to look up how to do the calculations. We do not have pumps on our units, but we do have dial-a-flows, and while not as accurate as a pump it gets the job done, and it is certantly easier than trying to count the drops in a 60 gtts set.

One of my co-workers, who is also a CCP, told me a method of figuring out the drip rate, but all I got out of it was a major headache. I suppose different methods for several people.

Once again, thats for the advice.

Hubbie

Okay, this is part of the problem with some Paramedic programs. How does one become a Paramedic without performing several weight based calculations? My college required math for pharmacology and I am sure we performed at least 50 Dopamine/ Pronestyl/ Antibiotics as well as long term IV drip problems.

First, using a Dial- A -Flow type of administration device on a supposed regulated medication drip, one is asking for litigation. The manufacture of the device plainly describes that it is NOT TO BE USED FOR ADMINISTRATION OF TIMED MEDICATIONS. As well, Dopamine is NOT THAT HARD TO FIGURE OUT. C'mon, surely one can watch 18 drops or even up to 45 drops per microdrip. i.e 3 drops per 15 seconds.

Here is a web site that goes over basic math for Paramedics. Please review it. It is not that hard. I am sure it will be a review. http://gaems.net/download/drugcalc.pdf You should had been taught this in your program. It is part of the profession as well as you are legally bound to know to perform these type of equation(s). (general medication administration, it is in the NHTSA curriculum)

This does make me wonder, does EMS agencies not give a pharmacology math test, upon hiring process or in refreshers? I would hope they would be responsible enough.

R/r 911

 

[Guardian]

I just joined a few minutes ago, so I am unsure if someone else has posted this. But I am looking for a quick and simple way of doing dopamine calculations on the fly. I know of the clock method, but does anyone else know of another method?

Hubbie

I'm a critical care paramedic who does neonatal and critical care transport, works in an ED, and runs high volume inner city ems. I've given dopamine. My advice, learn the method that works for all medications that they taught you in your paramedic course (hopefully this isn't the clock method). Then, use this method every time and nothing else. That way, you get really good at it and never make mistakes. Then, when you hear someone talking about some little shortcut they use to calculate dopamine; smile politely, while thinking to yourself what an idiot this person is for not having a good solid foundation to be able to calculate anything, anytime. I personally use and recommend the method in brady's basic paramedic books, but any good universal method would work. Trust me, when you’re under pressure to perform and giving multiple meds, your going to be glad/sad you learned it the right/wrong way.

 

[Guardian]

My exposure has been nothing short of prolonged and dramatic.

My agency (save the aberrent few) has been one of the premier agencies in the country for a long time. Having said abbreviation on your resume is historically a very good way to get a job.

At the end of the day our job is to transport to definitive care and stabilize enroute. If I wanted prolonged exposure to patients I would work for a hillbilly hodunk pondunk well then there rural agency (I don't have enough stuff for my belt) or go to medical school. No, I like ditch medicine and moving fast (we have some of the best pre-hospital penetrating trauma save rates in the country due to just that). If I am presented with a protracted tranport time i.e., intl airport into the city (15min), sure, I can hang with anyone.

When it is all said and done however we are ambulance drivers. I would love nothing more than to educate the public and everyone else about the difference but I don't see happening it in my lifetime. Untill then I will do what I can between A & B and accept that it is what it is ,a vocation, not a profession.

I don't know where you work but in my town no one expects medical care, it's "are you taking me to the effing hospital or not!". Unless, of course, you are in the 'hood and no one seems to think you are helping nana or the homeboy with the very non-acute problem quick enough. My pt. care population is confused enough.

Driving fast does not help, seconds never, ever count.

Egg

This is the type of mediocre mentality that is hurting our profession. Apathy, complacency, and pessimism are our biggest enemies. You exemplify all three. I do appreciate your honesty and candor though. Take a good look at this post folks, this is why we have failed to progress into a real profession and are in fact, regressing. We need to get away from the dumbed down, militaristic, and whacker mentality of ems. We need to embrace the fact we are medical professionals and more closely related to hospital personnel than cops and hose jockeys. This mentality is why I started posting on this forum in the first place. I want to eradicate it. Eggshen, I hope you post your opinions more often. I love straight talkers who aren’t worried about playing politics.

 

[eggshen]

Gaurdian, I don't think you read my post close enough, that or I was unclear, I am open to both. I exemplify none of those things. I spend my days doing what I can to improve my particular space in EMS. Of all those I have trained you can count on finding none that would agree with you, save of course those that have lost their jobs due to my honest and rather blunt evaluations and recommendations.

When referring to my post there seems to be a bit of digression. I am unsure how it is that I come across as dumbed down or militaristic. I cannot address whether or not I am a "whacker" as that seems to be some sort of colloquialism that is not used here.

When insisting that we are closer to hospital personnel than we are to cops or hose jockeys I am indeed at a loss as to how to tackle that one. How did I imply that we are cops? This next one you can trust me on, not meant to offend but I would not, ever, compare myself to a hose jockey (hose monkey here,). The hospital personnel thing is a tough one. There are a couple ways you can ride that one. I know some medics that are doctor smart, in fact I know more than a few. I do, however, know a precious few that can "get it to their hands". These people are the kind of medics that we should all emulate. The other lot? They are utterly useless. They can talk your ear off with all the neato medical stuff but where the rubber meets the road they tend to be best known for the goat f**k and do not impress me. I would gladly take 1 tight, streetwise medic with the common sense required to do the job over 10 of the other BS artists. It is those that think we should be more like hospital personnal that bog us down with those things that do just that. I am not opposed to having a broad and useful didactic base but if you can't make it work, lose it or move on to higher education where lab values and the like really do matter day to day.

When we come around to dope calcs I think you should learn to do it the right way. When you have that cracked lose it for something you can do on the fly if need be. Function over form. Out here Occams Razor rules. I am all about knowledge but the second it gets between you and your patient you need to sort yourself out and find a new line of work.

Gladly
Egg

 

[Guardian]

At the end of the day our job is to transport to definitive care and stabilize enroute.

That's not true at all. Some situations call for stabilization on scene before they are even moved to the ambulance. It's for situations like these that our profession was created. For example, you can't wait five minutes to shock someone in vfib.

No, I like ditch medicine and moving fast

Ditch medicine and moving' fast huh, aren't you the cowboy.

When it is all said and done however we are ambulance drivers. I would love nothing more than to educate the public and everyone else about the difference but I don't see happening it in my lifetime. Untill then I will do what I can between A & B and accept that it is what it is ,a vocation, not a profession.

All three of these sentences demonstrate complacency, apathy and pessimism.

When insisting that we are closer to hospital personnel than we are to cops or hose jockeys I am indeed at a loss as to how to tackle that one. How did I imply that we are cops?

I was just making a general statement, nothing against you personally.

I know some medics that are doctor smart, in fact I know more than a few. I do, however, know a precious few that can "get it to their hands". These people are the kind of medics that we should all emulate. The other lot? They are utterly useless. They can talk your ear off with all the neato medical stuff but where the rubber meets the road they tend to be best known for the goat f**k and do not impress me. I would gladly take 1 tight, streetwise medic with the common sense required to do the job over 10 of the other BS artists. It is those that think we should be more like hospital personnal that bog us down with those things that do just that. I am not opposed to having a broad and useful didactic base but if you can't make it work, lose it or move on to higher education where lab values and the like really do matter day to day.

This one says it all. These people who are "doctor smart" (not really, but compared to him, they are) are really the "good ones" that you are scaring away. Our skill sets really aren't that hard to attain, we just need a little practice. These "good ones" come in with an incredible knowledge but they are pushed away from the profession from people like you before they attain these skill sets. I read posts like yours all the time describing "street smarts" or common sense. I have yet to see a "book smart" paramedic without common sense. I think this is a figment of your imagination. Sure most of our smartest paramedics move on to other professions, but am I the only one who sees a problem with here?

 

[Guardian]

Common sense. Common sense is just that, common. It’s the median or middle. It’s mediocre. It’s the C student. It’s the bland brainwashed idiocy of the masses. We deal with common people all day long. Why would you want to be like that? Why not think outside of the box, maybe be an innovative thinker. Why would you limit yourself to that which is common? Since when did being common or thinking in a common way become such a prized social trait? Someone, please define common sense for me. I have no idea what it means. Are people with high IQs all idiot savants? Are they all radical, crazy, BS artists who can’t function in society? Where is your evidence to prove this theory because it goes against almost every social psychology study ever done. How do you define common sense and how do we know who has it and who doesn’t?

As long as we continue to push exceptional people away and overload ourselves with commoners, we will never progress where we should.

 

[Markhk]

Slightly back on thread, the one way NOT the calculate dopamine dosages is the "Rule of Six". The Broselow Tape had to be re-designed as it had this calculation on it. The Institute of Safe Medication Practices issued a safety alert about it a while ago, and JCAHO apparently now insists that hospitals not use it.

http://www.medscape.com/viewarticle/501053

Here's another question though:

- Would you smack (mentally, of course) a paramedic who pulled out a drug calculator?
- Would you think of a paramedic any less if they preferred to use a drug calculator in a clinical setting?

I've always been curious on this point, because as all of you know, the mind does strange things under pressure. It may be safer for patient care not to rely on memory or to do mental math. Pilots, for instance, are taught to follow check-lists as a key part of their training -- and to physically read it out every single time -- as the one time you "think" you did it, it probably wasn't done (or done right).

 

[Ridryder911]

Personally, I much rather have a Paramedic use a cheaters card, calculator, etc. as long as the Paramedic knowingly in fact can calculate that medication as well. This is an are the Paramedic has to be 100% effective. Sorry, the wrong number is going into the patients veins.

The point it is nice to have references, calculators, etc.. but, as anyone in EMS can assure, Murphy's law may happen. When it does, the Paramedic as a professional should be competent and knowledgeable enough to perform their job. Being able to perform drug calculations is one part of the job.

R/r 911