Mix 200 mg Dopa in a 250 bag, resulting in 800 mcg/cc. If running at 10 mcg/kg/min, the drip rate will be EXACTLY the pt's weight in kg multiplied by 0.75. Adjust accordingly for 400/250(1600 mcg/cc), and/or 5, 10, or 20 mcg/kg/min. Do the math, it will work out perfectly every time. Ever wonder why the LP12 three lead default is II, III, AvF? Some monitors don't have 12 lead capability. If you have a cardiac pt, and need to begin NTG therapy(time is muscle), you can change the monitor to diagnostic mode and rule out an inferior STEMI at least, so you can go ahead with nitro. Approx 30% of inferior wall MI's will have Rt vent involvement. Maybe you're the only ALS provider, and don't have the time to mess with a 12 lead in lieu of other therapies. Note that when you pace a pt, you should have both the pads and three lead hooked up. If a limb lead comes off, the pacing mode will change from demand to non demand. When monitoring a critical pt, the AED mode can be swiched on. If you're busy with an IV, tube, or drawing up meds, the monitor will alert you if V-Tach or V-Fib is detected. It will quickly grab your attention. Don't forget to switch off of AED mode afterward. Dialing up the QRS volume would be a good idea, also. When you are managing an SVT, your ears will pick up an irregular beat long before your eyes will. Some of these features may be exclusive to the LP 12. When preparing an IV drip, please make sure that you add the med to the solution and mix it before you spike the bag. I've witnessed some spike the bag, then add the med. You're getting only saline or D5 or whatever for the first minute or so. These are just some random thoughts and tips that I wanted to share. I encouage others to add their own to this thread.
Dopamine math made easy, and other random stuff
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They aren't that hard to set up. Have your basic do it. Just don't ask them to interpret it...
mikie
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And as long as they are proficient in lead placement!
You're missing the point. You can rule out inferior ischemia, initiate IV/ntg, and do a 12 while transporting. Not having to deal with shaving the Cx, a diaphoretic pt, or female clothing preventing access to the needed areas will shorten the contact to ED/Cath lab time by several minutes. Our engine LP 12's don't have 12 lead capability, but can be placed in diagnostic mode to circumvent this shortcoming. If the EMT is competent in lead placement, that's great. Some agencies will have you working with different partners quite often. You never know what you're getting. Also, if you run the inferior leads in diagnostic, you can begin reperfusion therapy while the 12 is being set up, not waiting a few minutes for set up, print, and analysis. Anything you can do to shorten Tx/Txp time while providing all appropriate interventions, should be done. In reality, we typically have so much quality help, that this wont be an issue.
mikie
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With all due respect, I'm not sure I understand the point of this thread...could you elaborate?? Are you saying we spend too much time on unnecessary procedures?
Not unnecessary, just a quicker way of doing things, in the interest of delivery to definitive care in a more rapid manner. Everything will get done, it's just a manner of doing it as quickly as possible. Defer a 12 lead momentarily if an inferior interpretation is performed, sure. Delay O2, or prophylactic IV prior to txp or drug therapy, absolutely not. For most pts, time is probably not of the essence. For some, they need definitive care at a hosp ASAP, and it's up to us to get them there expeditiously, while doing what needs to be done along the way. Too many times I've seen the crew sit onscene doing everything, and then leave the scene. Some pts need to be treated on the spot, and some can be moved to the bus after diagnostics with advanced interventions being done enroute to the hosp. In some instances, if the hospital is one or two blocks away, delivery to the ED may be more beneficial to the pt that sitting onscene to get everything in. I'm just interested in doing what's in the best interest of the pt. The OP was intended for people to weigh in with their own observations, clinical pearls, and methods. I didn't specify BLS because there already is an excellent thread devoted to EMT tricks of the trade. BLS is important, and I will occasionally learn a better way of doing things from a Basic.
HotelCo
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It's not that hard.
It's one of the skills which our emt-b preceptees have to have checked off prior to clearing.
mikie
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Agreed. But if someone is basing their placement off of "I saw them do it before" as opposed to their proper anatomical spots, big Oops! can happen.
MisLeading: The Clinical implications of misplaced ECG leads
^compliments to the origional poster of this article a few months ago
You don't need to turn on the AED mode on the LP12 to monitor for VF/VT.
There is an option for VF/VT detection on the monitor that will sound 5-8 seconds after it detects VF/VT. The icon with the magnifying class looking at the EKG indicates this feature is on. This is an option that can be disabled under the Alarms menu.
The feature doesn't work during TCP though. Also forces the monitor into Paddles or Leads II only.
A similar feature exists on the MRx...which you can't shut off. It just sounds the continuous "red" level alarm and blinks "VFIB/VTACH" upon detection. And then the monitor starts vomiting paper....
There is an option for VF/VT detection on the monitor that will sound 5-8 seconds after it detects VF/VT. The icon with the magnifying class looking at the EKG indicates this feature is on. This is an option that can be disabled under the Alarms menu.
The feature doesn't work during TCP though. Also forces the monitor into Paddles or Leads II only.
A similar feature exists on the MRx...which you can't shut off. It just sounds the continuous "red" level alarm and blinks "VFIB/VTACH" upon detection. And then the monitor starts vomiting paper....
Sorry, but the only item you are promoting is complacency. Taking the time to properly prep the chest and acquiring an appropriate 12 lead does not take that long and is a basic premise to acquisition of appropriate and reliable 12 lead EKG. Even an appropriately acquired 12 lead doe not rule out anything, enzymes are the only definitive when it comes to making the "yes or no" statement.
I say just do it right the first time.......................
I say just do it right the first time.......................
But to add a positive to the thread, Dopamine is actually even easier than previously described......................
Take the pts. weight in pounds, drop the last number and subtract 2. That will be your 5mcg/min drip rate.................
Or you could take the extra 20-30 seconds and actually do the math that was impregnated into all of our heads!
Take the pts. weight in pounds, drop the last number and subtract 2. That will be your 5mcg/min drip rate.................
Or you could take the extra 20-30 seconds and actually do the math that was impregnated into all of our heads!
MSDeltaFlt
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But to add a positive to the thread, Dopamine is actually even easier than previously described......................
Take the pts. weight in pounds, drop the last number and subtract 2. That will be your 5mcg/min drip rate.................
Or you could take the extra 20-30 seconds and actually do the math that was impregnated into all of our heads!
Amen, brother. I always wear a cheap $20 calculator watch from Wally World. That's my brain. It's the best thing since melted butter. I'll use up the full 30 seconds figuring out the drip rates if my gloved finger accidentally hits the wrong button... and it has.:blush:
Ridryder911
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How many, re-checks and verifies IV drips? I do. Too many times, I have flown for IFT in to find many of the drips at the wrong rate. So before changing over, I re-calculate.. amazing the errors one will find.
R/r 911
R/r 911
remote_medic
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daedalus
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I was taught
kg x mcg x .037 = gtts/min
for dopamine. anyone else using this?
kg x mcg x .037 = gtts/min
for dopamine. anyone else using this?
remote_medic
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No short cuts allowed around here
daedalus
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Eh, I suppose my patients pressure can zero out while I preform dimensional analysis. Hehehehe.
ResTech
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I studied and have the basic formula ingrained in my head:
mcgs/min x weight (kg) x drip set (60)
Total concentration (1600mcg)
400mg in 250cc = 1600mcg/mL
I never knew this!
mcgs/min x weight (kg) x drip set (60)
Total concentration (1600mcg)
400mg in 250cc = 1600mcg/mL
I never knew this!