Dopamine in RVI
- Thread starter jcroteau
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I haven't really talked or thought about this before. I have heard of people against raising the heart rate if the patient has ECG signs of an MI.
I personally believe that if the patient is symptomatic from bradycardia eg altered then they aren't getting good enough perfusion to their body and need their heart rate to increase. I would pace before giving dopamine. If they were still bradycardic refractory to pacing then I would start a dopamine drip. This is only because of my protocols being atropine -> pacing -> dopamine. I got the impression that electricity has less problems than giving drugs too, but I usually see this more for like cardioversion and defibrillation.
I personally believe that if the patient is symptomatic from bradycardia eg altered then they aren't getting good enough perfusion to their body and need their heart rate to increase. I would pace before giving dopamine. If they were still bradycardic refractory to pacing then I would start a dopamine drip. This is only because of my protocols being atropine -> pacing -> dopamine. I got the impression that electricity has less problems than giving drugs too, but I usually see this more for like cardioversion and defibrillation.
TXmed
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If Bradycardia is the cause of hypotension I would rather pace and then low dose dopamine but not so much to raise the rate higher than 80, tachycardia with AMI are associated with poor outcomes
TXmed
Forum Captain
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Your goal is to keep up the BP to perfuse the kidneys, you're not shooting for 120+ on the systolic just the mid 90's-100's
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It seems likely that the cause of hypotension in a right-side MI is some sort of bradycardia, block or otherwise. Given that I'd prefer to pace the patient rather than use dopamine. Pacing can be accomplished more quickly (hopefully) and should be more predictable (hopefully). If I can't pace, some sort of vasopressor would probably be in order.