Dopamine math made easy, and other random stuff
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Originally Posted by Flight-LP
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.
Reading some of the shortcuts to EKGs done by EMS and complacency by not prepping to do the test properly one should question if these companies do any QA on quality.
This should not become a peeing match that EMS is better than the hospital staff because you have found errors. EMS should actually have less errors than hospital staff because they are dealing with only one patient and not 10 at the same time. We know in the hospital that errors happen with medication and try our best to prevent them. However, there are some in EMS who perceive themselves to be perfect and sometimes this is also reflected by the shortcuts they take in procedures and education.
On the flip side, we do have problems with some CCTs that fail to note the concentration of the med on the pump and assume it is "just like what they use in the field" and start screwing with the settings. This is another reason why hospitals now have their own inhouse CCT staff. It also goes for those that try to "match" ventilator settings and measured pressures without understanding the differences between a portable "ATV" and an ICU ventilator.
If you can not handle criticism or having your work critiqued when it comes to quality patient care...find another occupation that is not in health care.
Thanks for the tip.
Last time I checked, We don't have the time or equipment to do serial cardiac enzyme screening in the field. Inferior ischemia would be the most important finding when evaluating a 12 for ischemic changes in regard to ntg/morphine therapy. If I had no help, and it would shorten the Tx/Txp time, the full 12 can be deferred for a few minutes. As I mentioned earlier, our engine LP12's don't have 12 lead capability.
Things I've mentioned earlier, such as a quicker way of doing dopamine math(I've done the math the proper way many times over to ensure accuracy of the kg X .75 method), and the inferior interpretation before the full 12(if I'm doing all ALS by myself), aren't omtting anything. Things still get done, no negligence or malpractice has transpired. I advocate practicing effective time management, doing things as efficiently as possible. Shortcuts ought not = omissions.
Hey everyone, how about we cut the nonsense and post tips, knowledge and such that can be helpful? It seems like some get their jollies by pointing out other's inadequacies. There are plenty of other threads available where you can tell others how dumb they are, and how they aren't fit for the field without 10 bazillion years of education. Not everyone has attended a stellar medic program. It's likely that some weren't absorbing everything due to fatigue, and missed a thing or two. We also forget things as the years go by. I was hoping this thread would prove helpful for some. Again, the dopamine thing could be helpful at 0300 hours, when you're half awake. Ive heard frequently that one should run dopa wide open, figure out the drip rate, and adjust. Now THAT'S an improper shortcut. My math is accurate, and is quicker than the long way.
Shortcuts should not be used to make up for inadequate education, no sleep or poor quality patient care.
In fact, I do not recommend shortcuts to people who do not have proper education or have not mastered quality patient care. I can also see shortcuts becoming very dangerous when some are too tired to think things through properly.
In fact, I do not recommend shortcuts to people who do not have proper education or have not mastered quality patient care. I can also see shortcuts becoming very dangerous when some are too tired to think things through properly.
As someone who infuses pressors regularly, I can tell you that I don't care what time of the day or night it is, I'm checking and rechecking the math. As Dopamine is usually the only pressor agent used by EMS (as it is the only one that can be continuously infused via a peripheral line, the rest strongy recommend or require central access), it is overutilized when not indicated, mismanaged, and them adverse effects can be critical. There are many methods of quickening the calculation, but if you don't know what it is exactly you are calculating, or even more importantly WHY you are calculating it, then you shouldn't be giving it.
I'm sure everyone enjoys hearing about others' "simplicities" in EMS, but many are nothing more than bad habits. As Vent pointed out, unless you are truly proficient in your practice of medicine, then you need to stick to the approved methodology.
Ridryder911
EMS Guru
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Amen! As one that understands to achieve the pressor level for Dopamine is actually at a high "toxic" range; that it is dose dependent upon what the medication will do and perform. Some physicians are even naive on this.
Many Paramedics still fail to recognize that it is NOT a "titrate to effect" medication, or understand the ranges of renal, mesenteric and alpha vasoconstrictive. All again upon the weight and dosage needed.
R/r 911
daedalus
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I thought new research was showing that the renal dose of dopamine is a myth, and even at small does the kidney may lose perfusion.
Shishkabob
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We were taught >209 you subtract 2, <209 you subtract 3. I tried doing it on a practice quiz they gave and it didn't add up... neither of the 2.
150 = 15
15-2 = 13gtts ???
15-3 = 12gtts ???
46youngs math adds up to 26gtts, and doing it the long way adds up to 26gtts.
I don't know how I got the really short way to work before, but it's not working for me now.
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ResTech
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All of the places I've seen and protocols I've read have the standard Dopamine mix of 400mg in 250mL which gives ya a 1600mcg concentration.
Everyone carries a cell phone which most have a built in calculator and if not buy a cheap calculator to keep in your pocket or onboard ur unit.
dose x weight(kg) x drip factor (60gtts)
Concentration (1600mcg)
To me that is simple... and simpler yet... carry a pocket guide with a Dopamine chart in it.
One of the hardest things I have found with some patient's IV's is actually setting the drip rate... to sit there and count the drops when the IV may be positional... running fast one minute, then slower the next... its sometimes hard to get an accurate drip rate without a pump.
I practice setting the drip rates in the ED when the physician orders x amount of fluid over an hour or whatever time. The RN is always like "do your thing" 'cause she is so used to using a pump.
Everyone carries a cell phone which most have a built in calculator and if not buy a cheap calculator to keep in your pocket or onboard ur unit.
dose x weight(kg) x drip factor (60gtts)
Concentration (1600mcg)
To me that is simple... and simpler yet... carry a pocket guide with a Dopamine chart in it.
One of the hardest things I have found with some patient's IV's is actually setting the drip rate... to sit there and count the drops when the IV may be positional... running fast one minute, then slower the next... its sometimes hard to get an accurate drip rate without a pump.
I practice setting the drip rates in the ED when the physician orders x amount of fluid over an hour or whatever time. The RN is always like "do your thing" 'cause she is so used to using a pump.
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It does work. What is half of 26????
It is correct, look at the concentration in the question. It states 200mg instead of the standard 400mg.
13 gtts per minute will deliver 5mcg/kg/min.
Or as ResTech pointed out, you can do it the good old fashion way.
5mcg x 70kg (approx.) x 60gtts / 1600 mcg = 13.125 gtts / minute.
My shortcut posted works directly with the standard 1600mcg concentration. You have to double it for the 800mcg concentration.
5mcg x 70kg (approx.) x 60gtts / 1600 mcg = 13.125 gtts / minute.
My shortcut posted works directly with the standard 1600mcg concentration. You have to double it for the 800mcg concentration.
Shishkabob
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Nevermind. midnight + me + math = not good. Need to work on that...
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AnthonyM83
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So I guess no one uses the "Fischer-Price" Los Angeles way?
Mix 400mg Dopamine into a 500ml NS bag.
Start at 30 mcgtts/min.
Titrate to BP of 90-100mmHg and signs of adequate perfusion.
Max of 120 mcggts/min.
Mix 400mg Dopamine into a 500ml NS bag.
Start at 30 mcgtts/min.
Titrate to BP of 90-100mmHg and signs of adequate perfusion.
Max of 120 mcggts/min.
**shaking head and sighing**
No, not wise. But expected from LA......................
One of the easiest formulas for dopamine out there and one of the least known for some reason.
(weight in kg x dose (ie XXmcg/kg/min))/25. Will give you gtts/min with a 60 set or ml/hr if you are using a pump. Only works for a 1600mcg/ml concentration but can easily be adjusted for others.
For the above pt: (68kg x 5)/25 340/25=13.5 (without using a calculator anyway), so 13gtt/min.
(weight in kg x dose (ie XXmcg/kg/min))/25. Will give you gtts/min with a 60 set or ml/hr if you are using a pump. Only works for a 1600mcg/ml concentration but can easily be adjusted for others.
For the above pt: (68kg x 5)/25 340/25=13.5 (without using a calculator anyway), so 13gtt/min.
Thanks for pointing out that my math works. I originally posted the shortcut to help people do things a little more efficiently, god forbid, but I got beef from a few people looking down their nose at me for not doing certain things the long drawn out way. If you can do the math the proper way, there's absolutely no reason not to use a shortcut. It's supposed to make things quicker, easier, more simple.
150 lb pt: 150/2 = 75, 75-7.5 = 67.5, 67.5 x 5 = 337.5, 337.5/800 = 0.421875, 0.421875 x 60 = 25.3125 gtt/min.
150 lb pt = 67.5 kg, 67.5 x 0.75=50.625, 50.625/2 = 25.3125 gtts/min. 50.625 is divided by two because my "pt's wt in kg x 0.75 = drip rate is for 10mcg/kg/min. I divided by two to adjust for 5 mcg/kg/min. This is for 200mg/250cc's.
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Thanks to all the others for their shortcuts. Don't limit it to dopamine math. Feel free to post "more efficient
" ways of doing things in other areas. Do I want to carry a heavy box in my arms for a distance, or would I rather put the box on a dolly? Would you rather run five miles to the store then carry groceries home, or would you prefer to take the car? Do I want to do things the long way, when a more efficient method is available, provided the end result is the same?
" ways of doing things in other areas. Do I want to carry a heavy box in my arms for a distance, or would I rather put the box on a dolly? Would you rather run five miles to the store then carry groceries home, or would you prefer to take the car? Do I want to do things the long way, when a more efficient method is available, provided the end result is the same?
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