Ok, here goes, the other night , elderly guy came in sob and chest hurting "some" very vaque about symptoms. so, chest pain protocol started and surprise , surprise troponin .5 . pt's wife stated , he is allergic to all pain meds. so , doc orders nitro drip, started to hang and low and behold bp drops to 50/38, no to the nitro and pull out the dopamine. doc orders to titrate til bp stabel. however, after titrating to 20mcg , bp still low at 60/44 . doc orders up to 30 mcgs , i am getting more than a little concerned by this time, doc has walked out , no where to be found and pt is crashing. ok, so now question is ???? has anyone ever gone up to or over 30mcg for dopamine and do you have a protocol for this? I work in a small town er and still new to the er setting but all my bells and whistles were going off and still have problem with the way the situation turned out. When asked doc if maybe something else could have been done diffrent, got an ugly answer. any comments would be appreciated. thanks