Dopamine & You

[spkaldor]

I'm doing a bit of informal research into EMS use of Dopamine.

In talking to quite a few Paramedics, I've found a range of opinions about Dopamine. Some say that their transport times are so short, they never get to that point in the protocols. Other say it is too complicated to calculate drip rates and start a second line, so they never bother to use it. Others say they just "run it wide open and titrate to effect". Others say it is always a base order, and they have base do all the calculations.

I'm interested in your attitude toward Dopamine. Do you use it?
-If no, is it because of transport times or complications in set-up? Is calculating a drip rate an issue? What is the biggest issue.
-If yes, do you have any shortcuts to getting set-up, calculating drips? Do you run wide-open and titrate?

Thanks!

[Jon]

Originally posted by spkaldor@Feb 11 2005, 01:23 PM
I'm doing a bit of informal research into EMS use of Dopamine.

In talking to quite a few Paramedics, I've found a range of opinions about Dopamine. Some say that their transport times are so short, they never get to that point in the protocols. Other say it is too complicated to calculate drip rates and start a second line, so they never bother to use it. Others say they just "run it wide open and titrate to effect". Others say it is always a base order, and they have base do all the calculations.

I'm interested in your attitude toward Dopamine. Do you use it?
-If no, is it because of transport times or complications in set-up? Is calculating a drip rate an issue? What is the biggest issue.
-If yes, do you have any shortcuts to getting set-up, calculating drips? Do you run wide-open and titrate?

Thanks!
From the -P student perspective, Dopamine is a great drug.

From what I see on the streets, the number one reason it isn't used is that it is down on the list, and takes too long to set up (as in "I can play with this, or do a diesel drip and be at the ED before I can have this running).

In the future, as pumps become more prevelent in prehospital units, I can see dopamine getting used more on "longer" transports.

Around here I can be knocing on an ED's door in 15 minutes from any of my territory. Some parts of the county might have a 25 minute or more ride, though, and that is where a good pressor can make the difference between life and death.


Jon

[ResTech]

Dopamine isn't used all that much in my area. It is in the protocols but transport times are usually pretty short and therefore Dopamine doesn't get started. But most of the time medics will run it wide and titrate to effect. Personally, if I were going to use Dopamine I would set the drip correctly to deliver the proper mcg/kg/min. I have a ALS field guide with a chart that tells you the drip rate for Dopamine so there is no calculation needed.

[rescuejew]

Here in the hood we use the 400mg/500mL concentration...and the way I was taught was to make a Dopamine clock, it makes it really easy for calculating how much to use if you guesstimate the pts weight. You can do it in your head, its quick, easy and wont destroy the pts kidneys...not sure if I can explain it without drawing it....may have to scan a picture...lol

[Ridryder911]

We use Dopamine routinely. Anytime presure below <90 & patient symptomatic & has not responded to fluid challenge. (non-trauma) Dependent on type of patient we will start at high messentric range before alpha range.

Just remember, Dopamine was not invented to raise B/P it just so happen to be a side effect in the alpha range, be sure to watch renal function.

Be safe,

Ridryder 911

[emt3225]

hey all.....does anyone know of any website that i can go to, that will explain to me how to do the math for dopamine :rolleyes: i'm taking my emt cc skills in a few weeks and they wont pass me unless i can do the dopamine drip..thanks :D

[rescuejew]

Find the pts weight in kgs: divide by two and subtract 10%
ex: 130lbs=65-6=59kgs

multiply kgs by mcgs: ex: 59kgs x 10mcgs=590mcgs

if you're using a 400mg/500mL concentration, convert the 400mgs to mcgs by multiplying by 1000=400,000mcg and divide that 500 which will give you a 800mcg concentration.

Now the fun part:

Draw a circle, and using a 60 gtt set start from the top of the circle, 60 gtt on the top, inside the circle, 30gtts at the bottom, 15 on the right and 45 on the left.

Put your total concentration at the top (in this case 800mcgs) half tat to 400 which goes on the bottom, 200 on the right and 600 on the left.

Based on the pts weight in kgs multipled by the dose to be given, totaling 590 mcgs, plot that number on the clock, which will be somewhere around 44 gtts/min.

If I havent explained this clearly, which is entirely possible, given thats its 0200 and I cant draw a picture, i could try to scan the "Dopamine clock" and email it to you.

Hope it helps!!
G

[emt3225]

Originally posted by rescuejew@May 5 2005, 12:41 AM
Find the pts weight in kgs: divide by two and subtract 10%
ex: 130lbs=65-6=59kgs

multiply kgs by mcgs: ex: 59kgs x 10mcgs=590mcgs




Thank you soo much for your help.. :D Atleast now i have a better understanding on how to figure out the math..Thanks again...

[rescuejew]

You're so welcome 3225, it makes it easy enough to do in your head while your working the code AND pass the test...I'm a total math retard!
:P

[emt3225]

Originally posted by rescuejew@May 6 2005, 12:36 AM
I'm a total math retard!

Well consider me math retard #2...I hate math with a passion..As soon as someone tells me it has to do with numbers i cringe... :rolleyes:

[Jon]

Originally posted by emt3225+May 6 2005, 09:24 AM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (emt3225 @ May 6 2005, 09:24 AM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-rescuejew@May 6 2005, 12:36 AM
I'm a total math retard!

Well consider me math retard #2...I hate math with a passion..As soon as someone tells me it has to do with numbers i cringe... :rolleyes: [/b][/quote]
My classmate should be #3... I, however acutally am sick in the head and LIKE math :rolleyes: :D

Jon

[rescuejew]

wait a minute...actually LIKE math?!?!?! What are you, some kind of sadist?? :o

[Ridryder911]

All of those are classic ways.. I had used them for years, then I found this one to be easier:

Weight in kg X mcg (desired doseage) divided by 27 = drips


i.e. 75 kg X 5 mcg divided by 27 =


75 X 5 = 375 divided 27 = 13.8 or 14 gtts


It works on all doses


Be safe,
Ridryder911

[rescuecpt]

Originally posted by MedicStudentJon+May 6 2005, 09:32 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (MedicStudentJon @ May 6 2005, 09:32 PM)</td></tr><tr><td id='QUOTE'> Originally posted by emt3225@May 6 2005, 09:24 AM
<!--QuoteBegin-rescuejew@May 6 2005, 12:36 AM
I'm a total math retard!

Well consider me math retard #2...I hate math with a passion..As soon as someone tells me it has to do with numbers i cringe... :rolleyes:
My classmate should be #3... I, however acutally am sick in the head and LIKE math :rolleyes: :D

Jon [/b][/quote]
I love math. :) It pays the bills quite well.

I was the go-to girl for drug math in class. Ask me now? Who knows. That's what medical control is for. :lol: :lol:

[Doctor B]

As an EMS Instructor one of the questions that was frequently asked regarding our Cardiogenic Shock protoclos was " The protocols state to fluid resuscitate with Saline first and if it doesn't work THEN switch to Dopamine. However it never originally addressed HOW MUCH Saline to give before changing over. Well, after getting that issue resolved (2000 cc' s for the Adults and 40cc's / per kg for the Peds. ) we are now starting to see a higher incidence of Dopamine use with great success.
As far as the math is concerned. First off, we carry the 800mg/ 500cc (1600mcg/ ml) concentration and the calculation we found is the easiest is the following:

It's commonly referred to as the Drop 2 method. What you do is take the patient weight IN POUNDS, drop the last number, and subtract 2 from the result. This will end in the patient's 5/mcg/kg/min drip rate. It plays out like this:

Pt. Wt. 185 lbs
Drop the last number = 18
Subtract 2 = 16
16 = Your starting drip rate. for 5/ mcg/ kg/min. If your concentration is 400mg/ 500cc's just double the number (32).

Hope this helps.

[rescuecpt]

Originally posted by Doctor B@May 27 2005, 10:34 AM
As an EMS Instructor one of the questions that was frequently asked regarding our Cardiogenic Shock protoclos was " The protocols state to fluid resuscitate with Saline first and if it doesn't work THEN switch to Dopamine. However it never originally addressed HOW MUCH Saline to give before changing over. Well, after getting that issue resolved (2000 cc' s for the Adults and 40cc's / per kg for the Peds. ) we are now starting to see a higher incidence of Dopamine use with great success.
As far as the math is concerned. First off, we carry the 800mg/ 500cc (1600mcg/ ml) concentration and the calculation we found is the easiest is the following:

It's commonly referred to as the Drop 2 method. What you do is take the patient weight IN POUNDS, drop the last number, and subtract 2 from the result. This will end in the patient's 5/mcg/kg/min drip rate. It plays out like this:

Pt. Wt. 185 lbs
Drop the last number = 18
Subtract 2 = 16
16 = Your starting drip rate. for 5/ mcg/ kg/min. If your concentration is 400mg/ 500cc's just double the number (32).

Hope this helps.
Great post, thank you! I was actually taught that method in class as well. I have yet to drip dopamine though, my transports in my one department are so short I barely get through standing orders, and for critical care EMTs dopamine is a medical control option.

The other department doesn't have a lot of calls. <_<

Thank you, and welcome to the forum! :lol:

[Doctor B]

You're welcome and thanks for the "Welcome".
The way I see it anything we can learn to make our job easier is a bonus!
Be safe

[Jon]

Originally posted by Doctor B@May 27 2005, 12:21 PM
You're welcome and thanks for the "Welcome".
The way I see it anything we can learn to make our job easier is a bonus!
Be safe
Let me be the 2nd to welcome you....


Jon

[rescuejew]

Let me be the third to welcome you Doctor B!! :D

Ive read all the posts and the other methods sound really easy but just too logical for me to use in practical application!!! lol

[rling]

Dope actually doesn't take that long to setup. On a code last night where we got pulses back, between my partner screaming to me to get get the scoop stretcher, scribe interventions, I was able to setup the bag in less than a minute.

Grab syringe, 1 inch IM needle, draw up drug (400mg in 5ml is our preparation), inject into 250 bag, give small shake, spike, flood line, label bag with "Dopamine 400mg in 5ml" on a piece of tape, hand to partner with smile.

My partner did the "wide open, then titrate to effect" method which confused me as I was taught to use the "drop 2" method. His method worked - brought BP up from 80/50 to 110/70.

[Outbac1]

We have dopamine here but it doesn't get used much. Usually the transport times are too short to get in a bolus and start a drip before arriving.
Its not that hard if you can remember some facts and ratios.
Double your concentration until you get mg/1000ml
Remember that mg/1000ml = mcg/ml. Divide by 1000

eg: 400mg/500ml = 800mg/1000ml = 800,000mcg/1000ml = 800mcg/1ml

Convert your lbs to kgs, divide by 2 and take away 10% and round off. You're estimating weight anyway why work with an odd number like 59.

eg: 130lb/2 = 65 - 6.5 = 58.5kg, round to 60kg.

Multiply your wt in kg by your desired dose.

eg:60kg x 5mcg/kg/min = 300mcg/min

60gtt/min = 1ml/min. Original concentration was 800mcg/1ml which is equal TO the following. All the following are the same strength. Just add the numbers you need to get your dose and gtt amount.

800mcg = 60gtt (1ml)
400mcg = 30gtt (.5ml)
200mcg = 15gtt (.25ml)
100mcg = 7.5gtt (.125)
50mcg = 3.75gtt (.0625)

200 mcg 15gtt
+100 mcg +7.5gtt
----- -----
300 mcg 22.5gtt / min

Round to 23. If you can keep it to one drop every two seconds in a moving truck you are probably doing good. At this strength 30gtt/min equals about 6.7 mcg/kg/min. Which is not a lot different than your desired dose.

Remember you are guessing the pts wt anyway and are likely to be wrong. You are in the back of a moving, bouncing truck. Any free hanging drip will not be accurate. If your medical director is that concerned about the drip dose in a bouncing truck they would mandate a pump. We don't have pumps for field use on calls but all our transfers with drips are on pumps.

[Emtgirl21]

My way is pt weight in pounds divided by 10 and subtract 2. that starts you out at 5mcgs.

Example. 100lb/10=10-2=8. thats the drip rate for 5mcgs.

also where is everyone coming up with these HUGE dopamine doses? For a 100kg pt at 20 mcg you should only be dripping 75ml/hr

[marineman]

this thread is 3 years old

[Jon]

this thread is 3 years old
So?
It is still on my ambulance.


And when a user DOES use the Search function, it makes KEVD18's blood pressure drop 5 points. :)

Jon

[BLSBoy]

We are taught the drop -1 method.

234lbs, drop last number, subtract one to get 5mcg/kg/min. And that is for a concentration of 1600mcg. (400mg in 250cc, or 800 in a 500cc bag)

So for 5mcg/mg/min for that 234lb pt, 22gtts/min is what you would set it at.

Is that exactly 5mcg/kg/min? No. But it comes pretty darn close.