How do you maintain med drip rates on your truck

[crotchitymedic1986]

You shouldnt buy them because I told you to, you should buy them because you are a patient advocate, and are concerned for your patient's safety.

I would say that it is a smarter use of money than buying 12-Lead, which no one hesitated to buy. If you can afford that, you can afford a new or reconditioned IV pump.

 

[JPINFV]

And I disagree that a study that was not published in a scientific journal is not worthy of review.

So if someone had an unpublished 'study' from an ambulance company and asked you to change your treatments based only on this study and some rhetoric, then you would do so without even a chance to see the study?

 

[crotchitymedic1986]

No, but if your own company's internal study showed a problem, would you ignore it because it wasnt published in JEMS (P.S. I also referenced published studies in that thread, all you have to do is google keywords to find them).

Do you have any study's that prove that it is not a problem ? Why dont you go back and just look at your 12/08 calls at your service? All you have to do is pull the refusals, then call the patients, and tell them as part of your service's follow-up, you wanted to check on them and make sure they are OK.

Wouldnt take you long, and then you can come back with real statistics and refute everything I have said (but I think we know what the statistics would show).

 

[Sasha]

You shouldnt buy them because I told you to, you should buy them because you are a patient advocate, and are concerned for your patient's safety.

I would say that it is a smarter use of money than buying 12-Lead, which no one hesitated to buy. If you can afford that, you can afford a new or reconditioned IV pump.

I'd say 12 leads are a lot more important than IV Pumps, a lot more frequently used. You have a pen and paper way of figuring out drip rates, and you have a manual way of setting them. You don't have a pen and paper way to figure out what's going on with the heart.

You didn't address the weight issue, by the way. What's your answer for that?

 

[Veneficus]

I'd say 12 leads are a lot more important than IV Pumps, a lot more frequently used. You have a pen and paper way of figuring out drip rates, and you have a manual way of setting them. You don't have a pen and paper way to figure out what's going on with the heart.

You didn't address the weight issue, by the way. What's your answer for that?

not all infusions are weight based.

I disagree that more pumps are needed, more educaton and training on how to properly set up a drip is needed.

 

[JPINFV]

No, but if your own company's internal study showed a problem, would you ignore it because it wasnt published in JEMS (P.S. I also referenced published studies in that thread, all you have to do is google keywords to find them).

JEMS is NOT a peer reviewed journal. May I suggest something like The Journal of Emergency Medicine to see what a real medical journal looks like?

Do you have any study's that prove that it is not a problem ? Why dont you go back and just look at your 12/08 calls at your service? All you have to do is pull the refusals, then call the patients, and tell them as part of your service's follow-up, you wanted to check on them and make sure they are OK.

I'm willing to bet that my current company had zero refusals on 12/08/08. Besides, QAing a call after the fact isn't the same as calling someone not on scene for 'permission' to not kidnap a patient. Yes, QA "studies" don't normally get published, but they also aren't used to change policy at companies outside of the company that the "study" arose from.

Wouldnt take you long, and then you can come back with real statistics and refute everything I have said (but I think we know what the statistics would show).

Real statistics like that AMR "study" that no one has seen?

 

[Sasha]

not all infusions are weight based.

I disagree that more pumps are needed, more educaton and training on how to properly set up a drip is needed.

But a good deal of them are! One of his primary examples, dopamine, is! So, you would still be estimating, which is why he's so pro pump.

 

[crotchitymedic1986]

Weight: Ask the patient, or estimate. It is not optimal, but it is all you can do with an unconscious patient who cant get on a scale.

So I guess your contention is that there are absolutely no safety issues with running meds off of a pump, therefore hospitals should stop using pumps and go to our method. Are you saying if your grandma's ICU nurse was administering a Heparin drip without a pump, you wouldnt say anything ?


And to prove my point, I will give you a dopamine drip problem that you cant look up on a chart. We will see how long it takes to get an answer, please show your math:

You need to administer dopamine to a premie baby that weighs 2.3kg. Please calculate the rate needed to administer 21mcg/kg/min of dopamine drip that has the concentration of 3200 mg (you doubled the dose to minimize fluid intake, as the infant has other meds running). You are using a 60gtt set.

 

[crotchitymedic1986]

If you will kindly go to the thread, as stated previously, i posted two of many studies i found on the internet that were in medical journals.

12/08 was referencing the month and year, not month and day.

 

[Chimpie]

Do you have a link to your thread?

 

[Sasha]

Weight: Ask the patient, or estimate. It is not optimal, but it is all you can do with an unconscious patient who cant get on a scale.

So I guess your contention is that there are absolutely no safety issues with running meds off of a pump, therefore hospitals should stop using pumps and go to our method. Are you saying if your grandma's ICU nurse was administering a Heparin drip without a pump, you wouldnt say anything ?


And to prove my point, I will give you a dopamine drip problem that you cant look up on a chart. We will see how long it takes to get an answer, please show your math:

You need to administer dopamine to a premie baby that weighs 2.3kg. Please calculate the rate needed to administer 21mcg/kg/min of dopamine drip that has the concentration of 3200 mg (you doubled the dose to minimize fluid intake, as the infant has other meds running). You are using a 60gtt set.

Yet your argument for pumps is that eyeballing it is an estimation! What is guessing a weight based drip rate to set a pump with, but an estimation? We are NOT the hospital, they can weigh all their patients. Have you not worked in the field? Got the "Uhhhh I don't know" answer, or an answer that is totally off from what they really do weigh? Had a patient tell you they're 200lbs as you load them onto the bariatric stretcher and struggle to get the siderails up? Or the "Uhhhhhm the last time I was weighed was at the doctor.... six years ago. "

So that would make IV pumps in the field just as useless and dangerous as eyeballing the drip rate, no? Because your dopamine drip is based off an estimation of the patient's weight.

 

[crotchitymedic1986]

It is the "ethical question" / refusal thread.

 

[crotchitymedic1986]

I am sorry I disagree. In your example, there is no better solution, as we can not weigh an unconscious patient. I realize that, and accept it, until stryker or ferno start putting scales on our stretchers. And you are correct, that if you put in bad info, you will get a bad output, but the same is true for eyeballing the rate, as you are using the same weight either way. But with a pump, your patient will not be accidentally overdosed because someone left the clamp wide open (ever hear of an EMS induced Lidocaine seizure), or will not get a 1000ccs of fluid when you meant to only bolus 250ccs, but again forgot the clamp. Most of today's pumps can calculate the drip rates for you, insuring you do not make a math error, and over or underdose your patient.

Very few medics have needle sticks or have caught hepatitis or HIV from their patients, but we use PPE, safety needles, and sharps containers to prevent those few occurences. You probably have a fairly low chance of crashing your ambulance today, but you always strap the patient down just in case. You probably have an intersection in town that is dangerous enough to make you slow down at the green light when driving L&S. I am willing to bet you probably dont have any employee that has been hit by a car, but i bet you wear something reflective when on the highway at night. This is no different.

 

[crotchitymedic1986]

No one has solved my Dopamine drip problem yet ?

 

[crotchitymedic1986]

My posts are not coming through for some reason. Most of the things we do in the name of employee or patient safety are to prevent events that rarely happen, but are catastrophic when they do occur.

No one has answered the dopamine drip calculation question I posted.

 

[Veneficus]

You need to administer dopamine to a premie baby that weighs 2.3kg. Please calculate the rate needed to administer 21mcg/kg/min of dopamine drip that has the concentration of 3200 mg (you doubled the dose to minimize fluid intake, as the infant has other meds running). You are using a 60gtt set.

21ug/kg/min on a medication with a maximum recommended dose of 20ug/kg/min makes me nervous. Time to step up to something a bit stronger possibly even ECMO in the NICU while you sort out whatever issue is causing you to have a neonate on multiple meds, including high dose pressors, and restricting fluid. I cannot imagine what EMS system would be running multiple meds on this patent out of an emergency truck and not IFT. (Which would mean all you are really doing is playing with the interventions already started in most cases)

Since 400mg of dopamine in a 250 bag of D5W is 1600ug/ml I would think that you mean 3200ug not 3200mg. Otherwise depending if you are using the adult or pediatric concentration of 75mg in 250 of a 40mg/ml solution, you are between 8-10x the normal concentration in the bag, not 2x.

But using the formula drops/min= volume x gtts/ml x desired dose/ volume on hand.

Adult: 250ml x 60gtts/ml x 48ug (2.3 kilo x 21ug/min) / 3200ug/ml = 225 drops/min

Why not step up to a 10 gtts?

250ml x 10gtts/ml x 48ug /3200ug/ml = 37.5gtts, 1 about every 2 minutes.

At the pediatric concentration: 75mg of 40mg/ml in 250ml you have: (1) 60gtts/ml/kg solution/minute = 5 ug/kg/min. 1 drop =5ug then 4 drops = 20. So 4 drops/min with double the concentration (4/2) and you get 2 drops/min.

Who needs a pump for 1 drop every 30 seconds?

 

[Veneficus]

I am sorry I disagree. In your example, there is no better solution, as we can not weigh an unconscious patient. I realize that, and accept it, until stryker or ferno start putting scales on our stretchers. And you are correct, that if you put in bad info, you will get a bad output, but the same is true for eyeballing the rate, as you are using the same weight either way. But with a pump, your patient will not be accidentally overdosed because someone left the clamp wide open (ever hear of an EMS induced Lidocaine seizure), or will not get a 1000ccs of fluid when you meant to only bolus 250ccs, but again forgot the clamp. Most of today's pumps can calculate the drip rates for you, insuring you do not make a math error, and over or underdose your patient.

Not trying to be a jerk, but it doesn't stop you from typing in 3200mg instead of 3200ug. At one hospital I work at we did an experiment with the preprogrammed dopamine drip on a pump and found it to be only accurate to the nearest whole number.

 

[crotchitymedic1986]

no i meant a concentration of 3200 mg of dopamine. And the point is to show the ability to calculate the drip correctly, which an IV pump can do every time.

 

[Veneficus]

no i meant a concentration of 3200 mg of dopamine. And the point is to show the ability to calculate the drip correctly, which an IV pump can do every time.

why would you put 8 or 10 times the concentration of a med in an IV bag and not switch to a more effective med?

 

[Veneficus]

no i meant a concentration of 3200 mg of dopamine. And the point is to show the ability to calculate the drip correctly, which an IV pump can do every time.

250ml x 60gtts/ml x .048 (ug converted to mg) / 3200mg = .225 drops min.

I would like to see the manufacturer specs for a pump that could do that. I seriously doubt it is that accurate.

I also want a cookie and a gold star for my work on this.